INtegrating Care After Exacerbation of COPD (InCasE)

慢性阻塞性肺病 (COPD) 恶化后的综合护理 (InCasE)

• 批准号: 9981429
• 负责人: David H Au
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2018-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9981429
• 关键词: Acute myocardial infarction; Admission activity; Caring; Chronic Obstructive Airway Disease; Clinic; Comorbidity; Congestive Heart Failure; Decision Support Systems; Discharge Plannings; Ensure; Environment; Fee-for-Service Plans; Fracture; Future; Geography; Goals; Guidelines; Health; Health Expenditures; Health Status; Healthcare; Healthcare Systems; Heart failure; Home environment; Hospital Mortality; Hospitalization; Hospitals; Improve Access; Informatics; Intervention; Lead; Lung; Medical; Medical center; Modeling; Patient Care; Patients; Pneumonia; Primary Health Care; Process; Quality of Care; Quality of life; Recommendation; Reporting; Research; Resources; Risk; Service delivery model; Services; Specialist; Standardization; System; Testing; Time; United States Centers for Medicare and Medicaid Services; Veterans; base; care delivery; care systems; chronic care model; design; efficacy study; evidence based guidelines; follow-up; geographically distant; health related quality of life; high risk; hospital readmission; improved; indexing; medical specialties; mortality; multi-component intervention; multidisciplinary; novel; organizational structure; patient population; programs; readmission rates; readmission risk; respiratory; response; satisfaction; successful intervention

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) exacerbations are common among Veterans admitted to hospital, lead to decrements in health-related quality of life, and are important drivers of health care expenditures. COPD exacerbation rivals chronic heart failure as the second leading cause of medical service discharges within VA. The readmission rate after exacerbations is high with as many as half of patients requiring readmission within 6 months. In contrast to initiatives targeting readmission for chronic heart failure, similar efforts do not exit for COPD. Our research suggests that VA potentially misses opportunities to augment care in response to COPD exacerbations despite a number of recent studies that demonstrate successful interventions to decrease future exacerbation risk. An intervention to improve COPD care is needed, not only to treat patients for COPD and their accompanying comorbidities, but also to redesign the care delivery system, such as specialties treating patients within Patient Aligned Care Teams (PACT). The current system reflects a process that is based on a fee-for-service model where specialists wait for patient referrals and do not assume responsibility for the health of a population of patients. Specialists are also geographically concentrated at major medical centers that are culturally and physically separated from the patient's medical home. Determining how to deploy existing specialties using a PACT-Veteran-centric approach is important to improve access, timeliness, and quality of care. We propose to test a novel intervention that is aligned with VA operational goals, and seeks to improve the quality of care among patients with COPD, improve their quality of life, and reduce their hospital re-admissions and mortality. Our specific aims include: Among patients who were discharged from hospital with an exacerbation of COPD: 1. Evaluate a multifaceted intervention that seeks to improve quality-of-life and decrease rate of hospital readmission and mortality among patients with COPD. The intervention leverages the VA's integrated healthcare and informatics system to facilitate the transition from hospital to home by using a multidisciplinary team to longitudinally support discharge and primary care teams in the care of patients recently discharged with a COPD exacerbation. The intervention is also designed to provide evidence about how VA may expand the responsibilities of specialists to better support patients during high risk periods. We hypothesize that the intervention will: 1a. Improve patient quality of life; 1b. Decrease hospital admission and mortality after hospital admission for COPD exacerbation. Secondary Aims 1. Assess whether the intervention improves COPD specific processes of care; 2. Assess whether the intervention improves Veterans' satisfaction with care; 3. Assess acceptability and satisfaction of the intervention to primary care clinicians.

描述（由申请人提供）： 慢性阻塞性肺疾病（COPD）在入院的退伍军人中很常见，导致与健康相关的生活质量下降，并且是医疗保健支出的重要驱动因素。 COPD加剧竞争对手慢性心力衰竭是VA内医疗服务出院的第二大主要原因。加重后的再入院率很高，多达一半的患者在6个月内需要再入院。与针对慢性心力衰竭再入院的倡议相反，类似的努力也不会退出COPD。我们的研究表明，尽管有许多最近的研究表明，弗吉尼亚州可能会错过增加护理的机会，以应对COPD加剧，这些研究表明了成功的干预措施，以降低未来的加剧风险。需要一项改善COPD护理的干预措施，不仅要治疗患者的COPD及其伴随的合并症，而且还需要重新设计护理服务系统，例如治疗患者对齐护理团队（PACT）中患者的专业。当前系统反映了一个基于收费服务模型的过程，专家等待患者转诊，并且对患者人群的健康不承担任何责任。专家也在地理上集中在主要的医疗中心，这些医疗中心在文化和物理上与患者的医疗之家分离。确定如何使用以契约为中心的方法来部署现有专业对于改善访问，及时性和护理质量非常重要。我们建议测试与VA操作目标保持一致的新型干预措施，并试图改善COPD患者的护理质量，改善其生活质量，并减少医院的重新吸收和死亡率。我们的具体目的包括：在患者中出院的患者中，COPD加剧了：1。评估多方面的干预措施，旨在提高COPD患者的生活质量和降低医院再入院和死亡率的降低。干预措施利用VA的综合医疗保健和信息学系统来促进通过多学科团队纵向过渡到家庭的过渡 在最近因COPD加剧而出院的患者护理中，支持出院和初级保健团队。该干预措施还旨在提供有关VA如何扩大专家的责任以更好地支持患者在高风险期间的证据。我们假设干预将：1a。改善患者生活质量； 1B。减少医院 住院后，COPD加重后入院和死亡率。次要目的1。评估干预是否改善了COPD特定的护理过程； 2。评估干预是否可以提高退伍军人对护理的满意； 3。评估对初级保健临床医生干预的可接受性和满意度。