PORTAL: Patient Outcome Reporting Tool for emergency medicAL services

门户网站：紧急医疗服务的患者结果报告工具

• 批准号: 10653774
• 负责人: Michael J. Ward
• 金额: $ 17.3万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653774
• 关键词: Academic Medical Centers; Acute; Acute myocardial infarction; Address; Ambulances; American Heart Association; Aspirin; Blood; Cardiac; Cardiovascular system; Caring; Chest Pain; Clinical; Cluster randomized trial; Collaborations; Communication; Data; Development; Diagnosis; Education; Educational workshop; Effectiveness; Electrocardiogram; Emergency Care; Emergency Situation; Emergency medical service; Encapsulated; Engineering; Environment; Evidence based practice; Failure; Feedback; Future; Goals; Guidelines; Health; Healthcare; Heart; Hospitals; Human; Incentives; Institution; Intervention; Interview; Intuition; Learning; Link; Lung; Measures; Medical; Medicine; Methods; Myocardial Infarction; National Heart, Lung, and Blood Institute; Nature; Notification; Operations Research; Outcome; Patient Care; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pattern; Performance; Physician Executives; Pre-hospital setting; Pre-hospitalization care; Prehospital Emergency Care; Preparation; Process; Provider; Qualifying; Qualitative Methods; Reperfusion Therapy; Reporting; Running; Safety; Secure; Service setting; Site; Structure; Survival Rate; System; Testing; Time; Visual; Work; acute care; behavioral outcome; biomedical informatics; burnout; cardiovascular emergency; care delivery; care systems; clinical center; clinical practice; compliance behavior; data exchange; design; effective intervention; effectiveness testing; electronic health information; emergency settings; evidence base; experience; field study; implementation evaluation; implementation outcomes; implementation research; implementation science; implementation/effectiveness; improved; improved outcome; intervention refinement; long-term sequelae; multi-component intervention; pragmatic trial; prevent; professional atmosphere; programs; provider adherence; provider behavior; randomized trial; randomized, clinical trials; service intervention; service providers; success; theories; tool; trial design; uptake; user centered design; wasting

ABSTRACT Nearly 28 million prehospital emergency medical services (EMS) ambulances runs occur annually for patients with cardiovascular emergencies. The American Heart Association recognizes the value of EMS in the Chain of Survival yet the inclusion of EMS necessitates logistically challenging communication amongst multiple organizations. Often, prehospital providers are unaware of their own practice patterns and patient outcomes wasting valuable opportunities to learn from experience while inadvertently reinforcing suboptimal care. Providing feedback on clinical practice and patient outcomes is a simple and effective intervention that has been challenging to scale. We will use human factors engineering principles (user-centered design) to develop, refine, and implement a scalable feedback system we call “PORTAL.” PORTAL uses automated audit and feedback, non-financial incentives, and local champions to examine the impact on provider behavior through the performance of guideline compliant care in the setting of cardiovascular emergencies. This application describes a mixed-methods proposal that addresses major NHLBI priorities to improve patient health through the development and refinement of the PORTAL feedback system for EMS providers delivering acute cardiovascular emergency care to patients with chest pain. The Specific Aims are: 1) Examine the determinants of guideline compliance amongst EMS providers and stakeholders; 2) Refine the visual interface for automated EMS feedback through user-centered design; and 3) Examine the feasibility and refine the implementation of the PORTAL intervention to support a subsequent trial testing the effectiveness of the feedback intervention. The team is uniquely qualified to accomplish these Aims, with expertise in care transitions, healthcare operations research, biomedical informatics, human factors engineering, implementation science, pragmatic trial design, qualitative methods, and acute care medicine. The institutional environment at Vanderbilt University Medical Center is outstanding, including the Center for Clinical Quality and Implementation Research (CCQIR), nationally ranked graduate programs in the relevant fields of study; and the national CTSA coordinating center. This application will develop an automated feedback system for prehospital providers treating patients with suspected cardiovascular emergencies. Taking a user-centered approach by placing the EMS provider at the center of the design process will substantially advance the ability to enhance provider activities through the delivery of scalable feedback using provider and stakeholder input. Advancing the delivery of prehospital provider feedback creates a mechanism to improve the quality and safety of prehospital care through the enhanced uptake of guideline compliant care. We propose this work in preparation for a cluster randomized trial evaluating the impact on provider behavior and patient outcomes.

抽象的 患者每年运行近2800万疗程前紧急医疗服务（EMS）救护车 与心血管紧急情况。美国心脏协会认识到EMS在链中的价值 生存但在逻辑上挑战多重沟通所需的EMS 组织。通常，院前提供者不知道自己的实践模式和患者的结果 浪费价值机会从经验中学习，同时无意间加强次优护理。 提供有关临床实践和患者结果的反馈是一种简单有效的干预措施 我们将使用人为因素工程原理（以用户为中心的设计）来开发， 完善，并实现我们称为“门户”的可扩展反馈系统。门户使用自动审核，并且 反馈，非财务激励措施和当地拥护者，以通过 在心血管紧急情况下，符合指南的护理的表现。 该应用程序描述了一个混合方法提案，该建议涉及改善患者的主要NHLBI优先级 通过为EMS提供商提供门户反馈系统的开发和改进，提供健康 急性心血管紧急护理给胸痛患者。具体目的是：1）检查 确定EMS提供者和利益相关者之间的准则合规性； 2）完善视觉界面 通过以用户为中心的设计自动EMS反馈； 3）检查可行性并完善 实施门户干预措施以支持随后的试验测试 反馈干预。 该团队具有实现这些目标的独特资格，并具有护理过渡，医疗保健方面的专业知识 运营研究，生物医学信息，人为因素工程，实施科学，务实 试验设计，定性方法和急诊医学。范德比尔特的机构环境 大学医学中心非常出色，包括临床质量和实施中心 研究（CCQIR），在相关研究领域的全国排名研究生课程；和国家CTSA 协调中心。 该应用程序将为治疗患者的院前提供商开发自动反馈系统 怀疑的心血管紧急情况。通过将EMS提供商放置在以用户为中心的方法 设计过程的中心将大大提高增强提供商活动的能力 使用提供商和利益相关者输入提供可扩展反馈。推进院前的交付 提供者的反馈创造了一种机制，可以通过 增强了符合指南的护理的吸收。我们建议这项工作以准备一个随机的群集 试验评估对提供者行为和患者预后的影响。