Enhancing Inter-Facility Transfer for Patients with Acute Myocardial Infarction

加强急性心肌梗死患者的机构间转运

• 批准号: 9198263
• 负责人: Michael J. Ward
• 金额: $ 16.48万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198263
• 关键词: Accident and Emergency department; Acute myocardial infarction; Address; Affect; Award; Behavior; Benchmarking; Biometry; Businesses; Cardiovascular system; Caring; Case Study; Characteristics; Clinical; Communication; Complex; Data; Development; Development Plans; Diagnosis; Doctor of Philosophy; Elements; Emergency Department Physician; Ensure; Environment; Evaluation; Event; Foundations; Funding; Future; Goals; Grant; Health Care Research; Health system; Healthcare Systems; Hospitals; Individual; International; Intervention; Interview; K-Series Research Career Programs; Knowledge; Lead; Manuscripts; Maps; Measurement; Measures; Mentors; Methods; Modeling; Myocardial Infarction; Myocardial Reperfusion; Organizational Culture; Outcome; Patient Care; Patient Transfer; Patient-Focused Outcomes; Patients; Performance; Play; Positioning Attribute; Preparation; Process; Public Health; Qualitative Methods; Qualitative Research; Reperfusion Therapy; Research; Research Personnel; Role; Science; Source; Surveys; System; Testing; Time; Training; United States; Variant; Writing; care delivery; career development; design; effective intervention; experience; field study; health care quality; improved; improved outcome; instrument; interdisciplinary approach; mortality; multidisciplinary; novel; operation; percutaneous coronary intervention; programs; public health relevance; skills; symposium; theories; therapy development; time interval; trial design

 DESCRIPTION (provided by applicant): In the U.S., nearly 500,000 patients suffer an ST-elevation myocardial infarction (STEMI) each year. Most emergency departments (EDs) lack the local capabilities to perform primary percutaneous coronary intervention (PCI) for myocardial reperfusion. Thus, patients must be transferred to capable facilities, but inefficiencies in this process cause delays in timely myocardial reperfusion and worsen patient outcomes. The time to reperfusion for transferred STEMI patients greatly lags behind those patients who present directly to PCI centers and fails to meet national benchmark standards in 90% of cases. Inadequate measurement and understanding of the timing and processes of care at transferring EDs has hindered improvement in the timeliness of STEMI patient transfer. Moreover, the study of relational coordination, communication, and organizational design, collectively known as "organizational behavior," is an accepted approach to study performance and variation in complex health systems. It has not yet been applied to the transfer of STEMI patients, but would likely reveal important targets for intervention. This proposal describes a career development plan that enables the candidate to gain expertise in how organizational behavior affects patient care, through the acquisition of advanced qualitative and quantitative skills for future implementation studies. The Specific Aims are: 1) Examine transferring ED data for factors associated with delays to myocardial reperfusion; 2) Conduct a detailed qualitative study of the practices that affect patient transfer for primary PCI; and 3) Examine the association between relational coordination and time spent at transferring EDs. The candidate is uniquely qualified as an emergency physician and PhD candidate in operations management. The career development plan builds on this foundation to provide: a) advanced skills in qualitative methods (e.g., patient and staff interviewing skills, and observation), biostatistics, and organizational theory; b) further development of scientific communication skills through manuscript preparation, grant writing, and conference presentations; and c) a multidisciplinary mentored research experience with international experts in transitions of care, qualitative research, process intervention development, and trial design. The institutional environment is outstanding, including a qualitative research center; nationally ranked graduate programs in the candidate's fields of study; and the national CTSA coordinating center. This career development award will allow the candidate to develop expertise in measuring the performance of healthcare systems during inter-facility patient transfer, a deep understanding of the relationship between system performance and patient outcomes, and targets for intervention to improve the timeliness of patient care for myocardial infarction. This award will position the candidate to become an R01-funded independent investigator who implements and evaluates process interventions to improve patient outcomes.

 描述（由应用程序提供）：在美国，每年将近500,000名患者患有ST-ETERVATION心肌梗塞（STEMI）。大多数急诊科（EDS）缺乏对心肌再灌注进行原发性经皮冠状动脉干预（PCI）的当地能力。这是必须将患者转移到有能力的设施中，但是在此过程中效率低下会导致及时的心肌再灌注和较差的患者预后。转移的STEMI患者再灌注的时间大大落后于直接出现在PCI中心并且在90％的病例中无法达到国家基准标准的患者。转移EDS时的测量和理解不足和了解护理的时间和过程阻碍了STEMI患者转移的及时性。此外，对关系协调，沟通和组织设计的研究（统称为“组织行为”）是一种研究复杂卫生系统绩效和变化的公认方法。它尚未应用于STEMI患者的转移，但可能会揭示干预的重要目标。该提案描述了一项职业发展计划，该计划使候选人能够通过获取先进的定性和定量技能来实现未来的实施研究，从而获得组织行为如何影响患者护理的专业知识。具体目的是：1）检查与心肌再灌注延迟相关的因素转移数据； 2）对影响原发性PCI患者转移的实践进行详细的定性研究； 3）检查关系协调与转移EDS所花费的时间之间的关联。该候选人被唯一地成为运营管理中的急诊医师和博士学位候选人。职业发展计划以此基础为基础，以提供：a）定性方法的先进技能（例如，患者和员工的面试技能，观察），生物统计学和组织理论； b）通过手稿准备，赠款写作和会议演讲进一步发展科学沟通技巧； c）具有国际护理，定性研究，过程干预开发和试验设计的国际专家的多学科指导研究经验。机构环境非常出色，包括定性研究中心；在候选人的研究领域中，全国排名的研究生课程；以及国家CTSA协调中心。这项职业发展奖将使候选人能够发展出在衡量患者间期间的医疗保健系统表现的专业知识，对系统绩效与患者结果之间的关系有深刻的了解，以及用于改善心肌梗死患者护理的及时性的目标。该奖项将使候选人成为一名由R01资助的独立研究者，他们实施和评估过程干预措施以改善患者的预后。