PRN Blood Pressure Medication Use in VA Hospitals: A Mixed Methods Approach

PRN 退伍军人医院血压药物的使用：混合方法

基本信息

批准号：
10424766
负责人：
Muna T Canales
金额：
--
依托单位：
VETERANS HEALTH ADMINISTRATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2023-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10424766
关键词：
Acute Acute Renal Failure with Renal Papillary Necrosis Address Admission activity Adverse effects Adverse event Age Algorithms Blood Pressure Caring Chronic Disease Clinical Clinical Data Cluster randomized trial Code Complement Consensus Costs and Benefits Data Data Sources Databases Development Diagnosis Discipline of Nursing Drops Educational Status Elderly Electronic Health Record Elements Event Future Goals Guidelines Healthcare Healthcare Systems High Prevalence Hospital Costs Hospital safety Hospitalization Hospitals Hypertension Hypotension Individual Informatics Inpatients Intervention Interview Intravenous Kidney Failure Knowledge Lead Literature Measures Medication Management Medicine Methodology Methods Motivation Nature Nurses Nursing Staff Patient-Focused Outcomes Patients Pattern Pharmaceutical Preparations Pilot Projects Population Predictive Factor Prevalence Process Provider Qualitative Research Renal function Research Research Technics Resource Informatics Resources Safety Stroke Sum Surveys Symptoms System Testing Time Variant Vascular System Veterans Work Workload blood pressure elevation blood pressure medication care costs cohort comorbidity cost cost outcomes data warehouse design experience falls health care service utilization high risk implementation intervention improved innovation novel older patient overtreatment pharmacy benefit safety outcomes sociodemographic factors sociodemographics tertiary care therapy design tool

项目摘要

Background: As many as 7 out of 10 hospitalized patients experience asymptomatic blood pressure (BP) elevations while in the hospital. However, no guidelines exist to guide the management of inpatient BP elevations. And, literature suggests treating these elevations with short-acting “as needed” BP medications (PRN BP), especially if asymptomatic, may be harmful. Despite this, many providers treat asymptomatic BP elevations with PRN BP. Significance: Adverse events due to overtreatment of inpatient BP elevations may lead to poor patient outcomes and higher hospitalization costs. Veterans, by virtue of older age and high prevalence of co- morbidities, are a population at high risk for adverse effects from inpatient BP treatment. Thus, it is vital to understand the practice patterns and provider motivations for PRN BP prescribing in VA hospitals in order to design interventions to target proper PRN BP use in hospitals. Such interventions can be tested for impact on safety and cost attributable to this practice. This work addresses VHA HSR&D priorities of Quality and Safety of Health Care, Health Care Value and Health Care Informatics. Innovation and Impact: The proposed work is novel in that it leverages extensive clinical electronic health record and administrative data and marries it with granular data from provider and nursing interviews (locally at a single VA hospital) and a national survey to better understand the full arc of predictors and motivations for prescribing in a low cost, timely fashion. Ultimately, the impact of this project is that it will provide fundamental infromation that will lead to the design, development and testing of interventions aimed at optimizing provider and nursing use of PRN BP. This intervention can be tested via cluster randomized trials to optimize related safety and costs of care. Specific Aims: Aim 1. To identify the prevalence of PRN BP use, and the sociodemographic and clinical factors associated with PRN BP use among Veterans hospitalized in VA hospitals nationally from FY16- FY20. Aim 2. To understand provider, nursing and system-level factors motivating PRN blood pressure use in VA hospitals through qualitative research techniques Methods: We will use VINCI resources to create a cohort from the national VHA of all Veterans consisting of all non-intensive care unit admissions to VA hospitals in FY16-20. Using several VA data sources including the Pharmacy Benefit Management and the Corporate Data Warehouse, we will define PRN BP use during hospitalization and collect diagnosis codes and specific clinical data including BP and kidney function measures. In Aim 1, will describe the prevalence of PRN BP prescribing and factors that predict prescription of PRN BP. In Aim 2, we will complement our findings from Aim 1 through 1 on 1 interviews with providers and nurses at a single VA tertiary care hospital to explore system-level and individual-level motivating factors for PRN BP use. We will use themes that emerge from interviews to design a survey to be distributed nationally to all VA inpatient providers and nurses to understand regional and institutional variations in drivers of PRN BP use. Next Steps/Implementation. Armed with new knowledge from this project, the next step will be to create an intervention that will be directed at optimizing inpatient PRN BP use for those with asymptomatic BP elevations. The intervention would then be tested locally and later nationally via cluster randomized trial to determine the impact of implementation on provider practice patterns and key safety and cost outcomes.

背景：多达十分之七的住院患者出现无症状血压 (BP) 然而，尚无指导住院患者血压管理的指南。并且，文献建议使用短效“按需”血压药物治疗这些升高。 (PRN BP)，尤其是无症状的血压，可能是有害的，尽管如此，许多医疗服务提供者仍治疗无症状的血压。与 PRN BP 的海拔高度。意义：住院患者血压升高过度治疗导致的不良事件可能导致患者病情恶化退伍军人由于年龄较大和合并症患病率较高。发病率是住院血压治疗不良反应的高风险人群，因此至关重要。了解 VA 医院 PRN BP 处方的实践模式和提供者动机，以便设计干预措施以在医院中正确使用 PRN BP 可以测试此类干预措施的影响。这项工作涉及 VHA HSR&D 的质量和安全优先事项。医疗保健、医疗保健价值和医疗保健信息学。创新和影响：拟议的工作是新颖的，因为它利用了广泛的临床电子健康记录和管理数据，并将其与来自提供者和护理访谈的详细数据结合起来（本地一家退伍军人管理局医院）和一项全国性调查，以更好地了解预测因素和动机的完整范围最终，该项目的影响在于它将提供基础性的处方。将导致设计、开发和测试旨在优化提供者的干预措施的信息 PRN BP 的护理使用可以通过整群随机试验进行测试，以优化相关的。安全和护理费用。具体目标：目标 1. 确定 PRN BP 使用的流行率以及社会人口统计学和临床 2016 财年至 2016 财年全国退伍军人管理局医院住院退伍军人中与 PRN BP 使用相关的因素 2020 财年目标 2：了解促进 PRN 血压使用的提供者、护理和系统层面的因素。退伍军人管理局医院通过定性研究技术方法：我们将使用 VINCI 资源从所有退伍军人的国家 VHA 中创建一个队列，其中包括 2016-20 财年退伍军人事务部医院的所有非重症监护室入院人数使用多个退伍军人事务部数据源，包括药房福利管理和企业数据仓库，我们将定义 PRN BP 在住院并收集诊断代码和具体临床数据，包括血压和肾功能在目标 1 中，将描述 PRN BP 处方的流行率以及预测处方的因素。 PRN BP。在目标 2 中，我们将通过与提供者的一对一访谈来补充目标 1 的发现。一家退伍军人管理局三级护理医院的护士探索系统层面和个人层面的激励因素 PRN BP 使用。我们将使用采访中出现的主题来设计一项调查，以便在全国范围内分发。所有 VA 住院服务提供者和护士了解 PRN BP 驱动因素的区域和机构差异使用。下一步/实施有了该项目的新知识，下一步将是创建一个旨在优化住院患者 PRN BP 对无症状 BP 患者的使用的干预措施然后，该干预措施将在当地进行测试，随后通过整群随机试验在全国范围内进行测试。确定实施对提供商实践模式以及关键安全和成本结果的影响。