Chronic Care Management Model Translation to Multimorbid Aging Adults at FQHCs

将慢性护理管理模式转化为 FQHC 的多病老年人

• 批准号: 8506930
• 负责人: Cindy Lou Corbett
• 金额: $ 37.39万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8506930
• 关键词: Academic Medical Centers; Acute; Admission activity; Adoption; Adult; Age; Age-Years; Aging; Attention; Caregivers; Caring; Chronic; Chronic Care; Chronic Disease; Clinical Trials; Clinical Trials Design; Collaborations; Communities; Computer software; Control Groups; Data; Education; Effectiveness; Federally Qualified Health Center; Goals; Growth; Health; Health Status; Healthcare; Home Care Services; Home environment; Home visitation; Hospitalization; Hospitals; House Call; Informed Consent; Institutional Review Boards; Intervention; Knowledge; Life; Medical Care Team; Metric; Mission; Modeling; Outcome; Participant; Patient Care; Patient-Centered Care; Patients; Prevalence; Preventive; Public Health; Quality of Care; Quality of life; Randomized; Recording of previous events; Research; Resources; Rural; Self Management; Services; Social Work; Social Workers; Staging; Structure; System; Techniques; Testing; Time; Translating; Translational Research; Translations; Visit; Washington; Work; Writing; arm; base; blind; care delivery; care seeking; cost; cost effective; cost effectiveness; empowered; evidence base; health care delivery; health related quality of life; high risk; improved; innovation; meetings; member; multiple chronic conditions; patient home care; patient oriented; primary outcome; programs; public health relevance; satisfaction

DESCRIPTION (provided by applicant): Despite high chronic care costs, patient care satisfaction, education, activation and outcomes are sub-optimal. Translational research to test innovative models that will empower high risk patients to manage chronic conditions in collaboration with their health homes while improving care outcomes is critically needed because of the growing prevalence of aging adults with multiple chronic conditions (i.e., multimorbidity), and the fiscal urgency for higher care quality without increased costs. The main objective of this application is to translate the Chronic Care Intervention (CCI) to aging adults with multimorbidity that have a high baseline rate of acute care utilization. To this end, the following specific aims will be achieved: 1) Evaluate the impact of the Chronic Care Intervention (CCI) on health activation among aging adults with multimorbidity and high baseline acute care use who have a Federally Qualified Health Center (FQHC) home; 2) Evaluate the impact of the CCI on acute care utilization among aging adults with multimorbidity and high baseline acute care use who have a FQHC home; and 3) Evaluate the cost-effectiveness of the CCI among aging adults with multimorbidity and high baseline acute care use who have a FQHC home. The CCI will be tested using a randomized, single- blind clinical trial design. Study entry criteria include FQHC home patients over 45 years of age (n = 300) who live in the community and have at least two chronic conditions. After IRB-approved written informed consent, participants will be placed into one of the two groups using a randomization software program that will stratify each participant across potential confounders. The intervention will be implemented by a RN and Social Worker team to provide intervention-arm participants with self-management support and care coordination such that participants are engaged as partners with their health team. Attention control intervention will be implemented by a Social Services Paraprofessional Aide who will provide control participants with information about available community resources for assistance in the home if they self-identify a need for such support. Participants and/or famil members/caregivers could then contact the community resource if they so desired. All participant will be assessed on pertinent outcomes (health activation scores, self-rated health status, and health-related quality of life) at baseline, 3, 6, 9, and 12 months. Acute care utilization data will be assessed at 3, 6, 9 and 12 months. The primary outcome for Specific Aim 1 will be participant activation stage. The main outcomes for Specific Aim 2 will be days to first ED visit or hospitalization and total number of ED visits and hospitalizations. The outcome for Specific Aim 3 will be health-related quality of life. To evaluate the aims, random-effects regression techniques will be performed to identify group differences on 1) patient activation over time, 2) ED visits and rehospitalizations, and 3) health-related quality of life over time. Th expected outcomes of the experimental intervention are that participant activation, health status ratings, and health-related quality of life will increase and that ED visits, hospital admissions, and costs will be reduced. This contribution is significant because it will advance knowledge about community partnerships and best practices to enhance the ability of health homes to provide patient-centered team-based care in a manner that engages activated and informed patients and results in more effective use of health care resources.

描述（由申请人提供）：尽管慢性护理费用很高，患者护理满意度，教育，激活和结果是最佳的。转化研究以测试创新模型，这些模型将使高风险患者与健康家庭合作管理慢性病，同时改善护理结果，这是由于具有多种慢性病（即多种多种疾病）的衰老成年人的越来越多，并且在没有增加成本的情况下，越来越多的慢性病（即多发性疾病）的患病率不断增长。该应用的主要目的是将慢性护理干预措施（CCI）转化为具有多种多发病的老年人，具有较高的急性护理利用率基线速率。为此，将实现以下具体目标：1）评估具有多发性和高基线急性护理使用者的慢性护理干预措施（CCI）对拥有联邦合格的健康中心（FQHC）住所的衰老成年人的健康激活的影响； 2）评估CCI对具有FQHC家的多发性和高基线急性护理使用的老年人对急性护理利用的影响； 3）评估CCI的成本效益在具有FQHC房屋的多发性和高基线急性护理的老年人中。 CCI将使用随机的单盲临床试验设计进行测试。研究进入标准包括居住在社区中并且至少有两个慢性病的45岁以上的FQHC家庭患者（n = 300）。经过IRB批准的书面知情同意书后，将使用随机软件程序将参与者放入两个组之一中，该程序将将每个参与者分为潜在的混杂因素。干预措施将由RN和社会工作者团队实施，以向干预组的参与者提供自我管理支持和护理协调，以便参与者与他们的健康团队合作。注意力控制干预措施将由社会服务专业助手实施，如果他们自我识别需要这种支持的需求，他们将为控制参与者提供有关可用社区资源的信息，以提供帮助。参与者和/或家庭成员/照顾者可以如果需要的话，可以联系社区资源。所有参与者将在基线3、6、9和12个月的基线时对相关结果（健康激活评分，自我评价的健康状况和与健康相关的生活质量）进行评估。急性护理利用数据将在3、6、9和12个月进行评估。特定目标1的主要结果将是参与者激活阶段。特定目标2的主要结果将是首次访问或住院以及急诊就诊和住院的总数。特定目标3的结果将是与健康相关的生活质量。为了评估目标，将执行随机效应回归技术以识别1）随着时间的推移患者激活的群体差异，2）ED访问和重新介绍以及3）随着时间的推移，与健康相关的生活质量。实验干预的预期结果是，参与者的激活，健康状况评级和与健康相关的生活质量将增加，而ED访问，住院入院和费用将降低。这项贡献是重要的，因为它将提高有关社区伙伴关系和最佳实践的知识，以增强卫生屋以与激活和知情的患者的方式提供基于患者的团队护理的能力，并导致更有效地利用医疗保健资源。