Organizational Determinants of ICU Telemedicine Effectiveness

ICU 远程医疗有效性的组织决定因素

基本信息

批准号：
9061809
负责人：
Jeremy M Kahn
金额：
$ 55.26万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-28 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9061809
关键词：
Address Adopted American Back Case Mixes Clinical Complement Complex Critical Care Critical Illness Data Effectiveness Evaluation Excess Mortality Geographic Locations Goals Health Hospital Administrators Hospitalization Hospitals Improve Access Individual Intensive Care Intensive Care Units Intervention Interview Knowledge Link Measurable Medicare Monitor Outcome Patients Policy Maker Procedures Publishing Qualitative Research Research Research Infrastructure Research Methodology Research Personnel Risk Adjustment Rural Hospitals Sampling Services Site Visit Surveys Techniques Technology Telemedicine Training United States Variant Visit Visual Work base beneficiary care delivery design effectiveness measure effectiveness research experience health care delivery improved innovation mortality novel programs rural area socioeconomic disparity success tool trend

项目摘要

DESCRIPTION (provided by applicant): Treatment in an ICU staffed by appropriately trained intensivist clinicians improves survival in critically ill patients. Yet many patients lack access o this level of critical care, particularly in small hospital and rural geographic areas, leading to excess mortality and creating significant socioeconomic disparities. To address this problem many hospitals have adopted ICU telemedicine, a health care delivery innovation which uses audio---visual technology to provide critical care services from a distance. By expanding access to high-quality critical care, ICU telemedicine has great potential to improve survival in critical illness. However, the success of telemedicine is hindered by critical deficiencies in our understanding of how and where this technology is best applied. Telemedicine is a complex intervention, and existing programs vary significantly in both the components of intervention and the clinical setting in which it is used. In turn, studies of telemedicine demonstrate mixed result, with some showing a large mortality benefit and others showing no benefit or even suggesting harm. As a result, decision makers have little guidance regarding how and where to use this potentially transformative technology, if at all. In this project we will address this knowledge ga by identifying the key clinical and organizational factors associated with ICU telemedicine effectiveness. Our central hypothesis is that objective, measurable, clinical and organizational factors will distinguish effective programs from ineffective ones. First, we will use national data on Medicare beneficiaries and an innovative risk--- adjustment procedure to quantify hospital---level variation in the impact of ICU telemedicine on patient mortality, ranking each hospital that has adopted ICU telemedicine from most effective to least effective. Second, we will conduct site visits at five hospitals with the greatest telemedicine effect and five hospitals with least telemedicine effect; along with two site visits at hospitals that have stopped using ICU telemedicine; performing in-depth qualitative analyses to identify the clinical and organizational factors associated with ICU telemedicine effectiveness. Third, we will develop and field a survey of all US hospitals that have adopted ICU telemedicine, linking the survey back to patient---level outcomes data and quantitatively defining ICU telemedicine clinical and organizational "best practices". By shifting the paradigm of ICU telemedicine evaluation away from whether it works to how and where it works best, this project will be the first rigorous examination of the factors that define successful ICU telemedicine implementation. Ultimately, these results will provide clinicians, hospital administrators with immediate, actionable data about how to use ICU telemedicine most effectively and efficiently, directly leading to improved access to critical care and improved survival for critically ill patients.

描述（由申请人提供）：由经过适当培训的强化临床医生组成的ICU治疗可改善重症患者的生存。然而，许多患者缺乏这种级别的重症监护，特别是在小型医院和农村地理区域，导致死亡率过多并造成了重大的社会经济差异。为了解决这个问题，许多医院采用了ICU远程医疗，这是一种医疗保健提供的创新，它使用音频 - - 视觉技术来从远处提供重症监护服务。通过扩大获得高质量重症监护的机会，ICU远程医疗具有改善关键生存的巨大潜力疾病。但是，远程医疗的成功受到了我们对最佳应用如何和何处的理解。远程医疗是一种复杂的干预措施，现有程序在干预措施和使用临床环境的组成部分中都有很大差异。反过来，对远程医疗的研究表现出不同的结果，有些结果显示出巨大的死亡率，而另一些则没有任何益处，甚至没有暗示伤害。结果，如果有的话，决策者几乎没有指导如何以及在何处使用这种潜在的变革性技术。在这个项目中，我们将通过确定与ICU远程医疗有效性相关的关键临床和组织因素来解决此知识GA。我们的中心假设是，客观，可衡量，临床和组织因素将有效计划与无效计划区分开。首先，我们将使用国家数据关于Medicare受益人和创新的风险 - 量化医院的调整程序 - ICU远程医疗对患者死亡率的影响的水平变化，对每家采用ICU远程医疗的医院对最有效至最小有效的医院进行了排名。其次，我们将在五家医院进行现场访问，具有最大的远程医疗作用和五个医院，远程医疗效应最少。除了在使用ICU远程医疗停止的医院访问中；进行深入的定性分析，以确定与ICU远程医疗有效性相关的临床和组织因素。第三，我们将对所有采用ICU远程医疗的美国医院进行调查，并将调查与患者联系起来 - - 级别的结果数据并定量定义ICU远程医疗临床和组织“最佳实践”。通过将ICU远程医疗评估的范式转移到是否有效和在何处运作的范围，该项目将是对定义成功ICU远程医疗实施的因素进行严格检查。最终，这些结果将为临床医生，医院管理员提供有关如何最有效，最有效地使用ICU远程医疗的立即，可行的数据，直接导致改善获得重症监护并改善了重症患者的生存率。