Optimizing Veteran Recovery from Sepsis (OVeR-Sepsis)

优化脓毒症退伍军人康复 (OVeR-脓毒症)

• 批准号: 10496554
• 负责人: Hallie Christine Prescott
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2025-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10496554
• 关键词: 2019-nCoV; Acute; Address; Administrator; Adopted; Awareness; COVID-19; COVID-19 pandemic; Caregivers; Caring; Censuses; Characteristics; Chronic; Clinical; Clinical Research; Clinics and Hospitals; Cognitive; Creativeness; Critical Care; Data; Diffusion; Disasters; Electronic Health Record; Epidemiology; Family; Functional disorder; Future; Goals; Guidelines; Health system; Hospitalization; Hospitals; Impaired cognition; Incidence; Infection; Intervention; Interview; Learning; Life; Managed Care; Marketing; Measures; Medical; Methodology; Methods; Modeling; Morbidity - disease rate; Nursing Research; Organ; Outcome; Patients; Pharmaceutical Preparations; Prevalence; Primary Care; Professional Organizations; Proxy; Public Health; Qualitative Research; Quality of life; Recommendation; Recovery; Research; Resolution; Respondent; Review Literature; Risk; Sepsis; Sepsis Syndrome; Series; Site; Site Visit; Standardization; Structure; Surveys; Survivors; Telephone; Veterans; Viremia; Work; World Health Organization; World Health Organization Disability Assessment Schedule; clinical implementation; clinical practice; cohort; coronavirus disease; design; disability; epidemiology study; experience; hospital readmission; implementation strategy; improved; informant; innovation; long term recovery; multidisciplinary; pandemic disease; primary caregiver; survivorship; tool; treatment guidelines; treatment research; virtual; 2019-nCoV; Acute; Address; Administrator; Adopted; Awareness; COVID-19; COVID-19 pandemic; Caregivers; Caring; Censuses; Characteristics; Chronic; Clinical; Clinical Research; Clinics and Hospitals; Cognitive; Creativeness; Critical Care; Data; Diffusion; Disasters; Electronic Health Record; Epidemiology; Family; Functional disorder; Future; Goals; Guidelines; Health system; Hospitalization; Hospitals; Impaired cognition; Incidence; Infection; Intervention; Interview; Learning; Life; Managed Care; Marketing; Measures; Medical; Methodology; Methods; Modeling; Morbidity - disease rate; Nursing Research; Organ; Outcome; Patients; Pharmaceutical Preparations; Prevalence; Primary Care; Professional Organizations; Proxy; Public Health; Qualitative Research; Quality of life; Recommendation; Recovery; Research; Resolution; Respondent; Review Literature; Risk; Sepsis; Sepsis Syndrome; Series; Site; Site Visit; Standardization; Structure; Surveys; Survivors; Telephone; Veterans; Viremia; Work; World Health Organization; World Health Organization Disability Assessment Schedule; clinical implementation; clinical practice; cohort; coronavirus disease; design; disability; epidemiology study; experience; hospital readmission; implementation strategy; improved; informant; innovation; long term recovery; multidisciplinary; pandemic disease; primary caregiver; survivorship; tool; treatment guidelines; treatment research; virtual

Background. Sepsis—life-threatening organ dysfunction triggered by infection—hospitalizes more than 25,000 Veterans each year, making it the 2nd most common reason for hospitalization in the VA. While most Veterans survive the acute episode, many suffer poor longer term outcomes. Approximately 1 in 3 survivors die in the year following sepsis, 1 in 5 have a potentially preventable rehospitalization, and 1 in 6 experience severe persistent physical or cognitive impairments. The dramatic increase in sepsis from COVID-19 brings new urgency to optimizing sepsis survivorship, but also new opportunity to learn from hospitals implementing recovery-focused practices to address the needs of Veterans surviving viral sepsis from SARS-CoV-2. Significance. Despite the prevalence of long-term morbidity after sepsis, there are no treatment guidelines focused on enhancing recovery from sepsis. OVeR-Sepsis will meet an urgent clinical need in VA, enhancing the recovery of the thousands of Veterans who survive sepsis each year (including viral sepsis from COVID). OVeR-Sepsis will validate best practices for enhancing recovery from sepsis that are responsive to Veteran and caregiver perspectives and identify feasible strategies for implementation. We will make these tools freely available, easy to use, and promote them nationally to encourage their use. Innovation and Impact. OVeR-Sepsis is innovative by studying sepsis survivorship systematically and broadly. We will study survivorship from both COVID and non-COVID sepsis, and consider how innovation in COVID sepsis survivorship practices can inform practice for non-COVID sepsis survivors. Our sequential explanatory mixed methods approach, with video site visits for 4-6 top- and 4-6 bottom- performing sites for sepsis survivorship, will allow us to study of clinical practices and implementation strategies that differentiate top-performing sites. We will then incorporate qualitative findings from our site visits into the evidence synthesis informing a modified Delphi panel to assess best practices for sepsis recovery. Specific Aims. (A1) Identify top- and bottom-performing VA hospitals for 90-day survival and quality of life after sepsis. (A2) Define practices that differentiate top-performing hospitals through electronic health record analysis, surveys, and video site visits. (A3) Prioritize best practices for sepsis recovery based on validity, improvement opportunity, and feasibility. Methodology. We will measure risk-standardized 90-day survival from sepsis across VA hospitals using hierarchical regression models and 2017-2020 CDW data. We will then empanel a cohort of N=600 Veterans from (25 Veterans per hospital, from 12 higher- and 12-lower survival hospitals) to measure quality of life and disability using telephone survey instruments with proxy respondent options. From those, we will select 4-6 top-performing (higher survival, high quality of life) and 4-6 bottom- performing hospitals for 360-degree video site visits. Through quantitative analyses of select practices, survey of current practices, and semi-structured interviews with a diverse set of 12-15 informants (clinicians, administrators, Veterans, caregivers), we will identify “best practices” for sepsis recovery and associated implementation strategies. Using a modified Delphi panel of experts, we will assess the validity, improvement opportunity, and feasibility of these best practices. Next Steps/Implementation. Upon successful completion of this research, we will work with our operational partners—who we have included even in the design stage of this IIR—to implement these best practices.

背景。败血症 - 威胁性的器官功能障碍是由感染触发的 - 使得超过 每年有25,000名退伍军人，成为VA住院的第二个最常见的原因。尽管 大多数退伍军人在急性发作中幸存下来，许多长期成果较差。大约三分之一 幸存者在败血症后的一年死亡，五分之一的人可能具有可预防的再住院，1 在6中经历严重的持续性身体或认知障碍。败血症的急剧增加 从Covid-19带来新的紧迫性来优化败血症生存，但也有新的学习机会 从实施以恢复为重点的做法的医院来满足幸存的退伍军人的需求 SARS-COV-2的病毒败血症。 意义。尽管败血症后的长期发病率普遍存在，但仍未治疗 指南重点是增强败血症的恢复。过度销售将满足紧急临床需求 在弗吉尼亚州，加强每年生存败血症的数千名退伍军人的恢复（包括 covid的病毒败血症）。过度销售将验证最佳实践，以增强败血症的恢复 对退伍军人和照顾者的观点的反应，并确定可行的策略 执行。我们将免费提供这些工具，易于使用，并在全国范围内推广它们 鼓励他们使用。 创新和影响。通过系统和 广泛。我们将研究来自共同和非卵巢败血症的生存，并考虑如何 Covid败血症生存实践的创新可以为非卵巢败血症生存的实践提供指示。 我们的顺序挖掘混合方法方法，视频场地访问4-6个上和4-6个底部 - 为败血症生存的表演地点，将使我们能够研究临床实践和实施 区分最佳网站的策略。然后，我们将从我们的定性发现中纳入 现场访问证据综合，告知修改后的Delphi面板，以评估最佳实践 败血症恢复。 具体目标。 （A1）确定90天生存和质量的顶级和最低表现的VA医院 败血症后的生活。 （A2）定义通过电子区分表现最佳医院的实践 健康记录分析，调查和视频现场访问。 （A3）优先考虑败血症恢复的最佳实践 基于有效性，改善机会和可行性。 方法论。我们将衡量VA医院的败血症的风险标准化的90天生存 使用分层回归模型和2017-2020 CDW数据。然后，我们将雇主一组 n = 600名退伍军人（每位医院25名退伍军人，来自12个高级和12磅的生存医院） 使用带有代理响应选项的电话调查工具来衡量生活质量和残疾。 通过这些，我们将选择4-6个表现最佳（高生存率，高质量的生活）和4-6个底部 - 进行360度视频网站访问的医院。通过对某些实践的定量分析， 对当前实践的调查以及对潜水员的12-15名线人的半结构化访谈 （临床医生，管理员，退伍军人，看护人），我们将确定败血症恢复的“最佳实践” 和相关的实施策略。使用修改后的Delphi专家面板，我们将评估 这些最佳实践的有效性，改进机会和可行性。 下一步/实现。成功完成这项研究后，我们将与我们的 运营合作伙伴（即使是在此IIR的设计阶段也包括在内）来实施这些 最佳实践。