Testing biopsychosocial mechanisms of the posthospital syndrome model of early rehospitalization in acute coronary syndrome patients

测试急性冠脉综合征患者早期再住院的院后综合征模型的生物心理社会机制

• 批准号: 9406011
• 负责人: Donald Edmondson
• 金额: $ 21.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 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/9406011
• 关键词: Accident and Emergency department; Acute; Acute Disease; Admission activity; Affordable Care Act; Aging; Biological Markers; Body Weight decreased; Cardiac; Caring; Characteristics; Comorbidity; Data; Distress; Ecological momentary assessment; Emergency department crowding; Enrollment; Environment; Environmental Risk Factor; Event; Goals; Health; Hospitalization; Hospitals; Hour; Intervention; Intuition; Length of Stay; Light; Lighting; Measures; Mediating; Modeling; Monitor; Myocardial Infarction; Noise; Outcome; Patients; Personality; Physical activity; Physicians; Politics; Population; Process; Psychological Stress; Public Health; Regulation; Reporting; Research; Research Personnel; Risk; Risk Factors; Risk stratification; Severities; Sleep; Social support; Stress; Syndrome; Testing; Time; Unstable angina; Voice; actigraphy; acute coronary syndrome; base; biopsychosocial; cohort; design; experience; high risk; hospital readmission; improved; indexing; pressure; public health relevance; therapy design

 DESCRIPTION (provided by applicant): The hospital environment was designed for treatment of acute illnesses, and has evolved unsystematically over the past century based on financial, demographic, and political pressures. We have become expert at treating acute cardiac events in particular, but new evidence suggests that hospitalization itself may weaken our patients -- rendering them susceptible to a host of maladies while they recover. A recent study of 500,000 cardiac admissions found that 1 out of every 5 patients was rehospitalized within 30 days of their discharge. Surprisingly, only half of those rehospitalizations were for cardiac reasons. Because of new financial regulations in the Affordable Care Act that tie reimbursement to rehospitalization rates, hospitals are highly motivated to decrease these early rehospitalizations. A new model of "posthospital syndrome" (PHS) suggests that the stress of hospitalization itself confers increased risk of rehospitalization because it places patients in a transient state of generalized risk. Testing this model, and identifying hospital environment and patient factors that place patients at risk, are crucial for directing hospital efforts to reduce 30-day rehospitalizations. The first goal of this proposed research is to test the PHS model to explain the high risk of all-cause rehospitalization experienced by cardiac patients in the 30 days after they are discharged. The second goal is to identify modifiable hospital factors that contribute most to PHS, and by doing so detect targets for reducing early hospital readmissions. The third goal is to identify patient factors, such as personality and social support that may be associated with PHS, so that we can ultimately conduct risk stratification and improve patients' successful transition to independent post-hospital care. We plan to enroll a consecutive cohort of 1,000 cardiac patients who are admitted through the emergency department (ED), follow them throughout their hospitalization, and identify 30-day rehospitalizations. We will assess 4 in-hospital risk factors: stress using ecological momentary assessment (EMA); sleep and physical activity by actigraphy; and weight loss by electronic scale. We will also objectively assess hospital factors that may contribute to stress: stressful environmental factors (degree of ED crowding and length of stay [LOS]; excess noise and lighting throughout hospitalization). Further, we will measure patient factors that may influence the hospital experience, including personality, social support, cardiac severity, and physical and psychiatric comorbidities during and after hospitalization. Finally, we will test whether in-hospital stress (and secondarily, physical activity, sleep, or weight loss) contribute to 30-day rehospitalizations. More than 1 million cardiac patients are hospitalized in the US annually, and 20% are rehospitalized within 30 days. All of the factors that have been hypothesized to contribute to PHS are modifiable, but evidence of their association to rehospitalization is required to motivate change. This study would be the first to test whether change is warranted, and to provide targets for intervention. As such, the impact of this research is substantial.

 描述（由申请人提供）：医院环境是为治疗急性疾病而设计的，在过去的一个世纪中，由于财政、人口和政治压力，我们已经成为治疗急性心脏事件的专家，但这是新的。有证据表明，住院治疗本身可能会削弱我们的患者——使他们在康复期间容易患上多种疾病。最近一项针对 500,000 名心脏病患者的研究发现，每 5 名患者中就有 1 人在住院期间再次住院。令人惊讶的是，在出院 30 天后，只有一半的再住院是由于心脏病原因，因为《平价医疗法案》中的新财务规定将报销与再住院率挂钩，因此医院非常积极地减少这些早期再住院。 一种新的“院后综合症”（PHS）模型表明，住院本身的压力会增加再住院的风险，因为它使患者处于短暂的普遍风险状态，并确定导致患者处于短暂状态的医院环境和患者因素。风险，对于指导医院努力减少 30 天再住院至关重要。这项拟议研究的首要目标是测试 PHS 模型，以解释心脏病患者经历的全因再住院的高风险。第二个目标是确定对 PHS 影响最大的可改变的医院因素，并通过这样做确定减少早期再入院的目标。第三个目标是确定患者因素，例如个性和社会支持。可能与 PHS 相关的信息，以便我们最终能够进行风险分层并改善患者成功过渡到独立的院后护理。我们计划连续招募 1,000 名通过急诊科 (ED) 入院的心脏病患者，跟随我们将在住院期间对他们进行评估，并确定 4 项住院风险因素：使用生态瞬时评估 (EMA) 进行的压力；通过体动记录仪进行的睡眠和体力活动；以及通过电子秤进行的体重减轻。可能造成压力的医院因素：压力环境因素（急诊室拥挤程度和住院时间[LOS]；住院期间的过度噪音和照明）此外，我们将测量可能影响医院体验的患者因素，包括个性、社交）。支持，最后，我们将测试住院期间的压力（其次是体力活动、睡眠或体重减轻）是否会导致超过 100 万心脏病患者再次住院。在美国，每年有 20% 的人在 30 天内再次住院。所有被利用来促进 PHS 的因素都是可以改变的，但它们与再住院相关的证据尚不清楚。这项研究将是第一个测试变革是否必要的研究，并提供干预目标。 因此，这项研究的影响是巨大的。