Adapting Enhanced Recovery Programs (ERPs) through Health Literacy to Eliminate Surgical Disparities

通过健康素养调整加速康复计划（ERP）以消除手术差异

• 批准号: 10658153
• 负责人: Daniel I Chu
• 金额: $ 61.95万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658153
• 关键词: Acceleration; Address; Adopted; Adoption; Adult; Affect; Alabama; Area; Attitude; Colorectal Surgery; Communication; Data; Databases; Deep South; Disparity; Foundations; Goals; Health; Health Care Costs; Institution; Intervention; Interview; Knowledge; Length of Stay; Machine Learning; Maintenance; Measures; Methods; Mission; Modeling; National Institute on Minority Health and Health Disparities; Needs Assessment; Nurses; Operative Surgical Procedures; Organization administrative structures; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Perioperative Care; Pilot Projects; Population; Process; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Registries; Research; Rural; Science; Site; Standardization; Structure; Surveys; Techniques; Testing; Training; United States; United States National Institutes of Health; Visual Aid; Vulnerable Populations; Work; black patient; design; disparity elimination; disparity reduction; experience; health assessment; health communication; health literacy; high risk; hospital readmission; implementation fidelity; implementation framework; implementation science; implementation strategy; improved; improved outcome; in vivo; innovation; literacy; literate; low health literacy; medical specialties; novel; older patient; patient engagement; pilot test; poor health outcome; programs; provider communication; racial disparity; readmission risk; recruit; response; rural patients; surgery outcome; surgical disparities; theories; vision science; Acceleration; Address; Adopted; Adoption; Adult; Affect; Alabama; Area; Attitude; Colorectal Surgery; Communication; Data; Databases; Deep South; Disparity; Foundations; Goals; Health; Health Care Costs; Institution; Intervention; Interview; Knowledge; Length of Stay; Machine Learning; Maintenance; Measures; Methods; Mission; Modeling; National Institute on Minority Health and Health Disparities; Needs Assessment; Nurses; Operative Surgical Procedures; Organization administrative structures; Outcome; Pathway interactions; Patient-Focused Outcomes; Patients; Perioperative Care; Pilot Projects; Population; Process; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Registries; Research; Rural; Science; Site; Standardization; Structure; Surveys; Techniques; Testing; Training; United States; United States National Institutes of Health; Visual Aid; Vulnerable Populations; Work; black patient; design; disparity elimination; disparity reduction; experience; health assessment; health communication; health literacy; high risk; hospital readmission; implementation fidelity; implementation framework; implementation science; implementation strategy; improved; improved outcome; in vivo; innovation; literacy; literate; low health literacy; medical specialties; novel; older patient; patient engagement; pilot test; poor health outcome; programs; provider communication; racial disparity; readmission risk; recruit; response; rural patients; surgery outcome; surgical disparities; theories; vision science

PROJECT SUMMARY Rationale: Low health literacy affects over a third of surgical populations and is associated with significantly worse outcomes in surgery. Interventions that reduce disparities in this large population are urgently needed. Our team has previously shown that enhanced recovery programs (ERPs) mitigate racial disparities in surgical outcomes and offer a pragmatic way to address surgical disparities. Existing ERPs, however, work poorly for patients with low health literacy who still experience worse outcomes. This gap arises from the lack of fit between current ERPs and the needs of low health literacy patients. Through a K23, our team assessed these needs and developed a novel multilevel strategy to improve fit: engage patients with VISuAl aids, Coach providers in communication, and Train organizations in health literacy (VISACT). An opportunity now exists to deliver and test the VISACT using a theory-based adaptation framework. Successful adaptations would transform existing ERPs and broaden its disparity-reducing impact to low health literacy populations. Objectives: Our long-term objective is to eliminate disparities and improve outcomes for low health literacy populations in surgery through context-driven adaptations of existing ERPs. We hypothesize that VISACT will improve fidelity to ERP’s components for low health literacy patients and thereby surgical outcomes. To achieve our objective, we aim to: (SA1) identify the health literacy-sensitive components of ERPs to augment with VISACT, (SA2) assess the health literacy needs of providers and organizational units on ERP teams, and (SA3) deliver and pilot test the VISACT implementation strategy on existing ERPs. Methods: Guided by the Dynamics Adaptation Process framework, we will first use machine learning on a large ERP database (n>7,000) to identify the health literacy- sensitive components of ERPs to augment with VISACT (SA1). Second, we will use a convergent mixed- methods integrative approach to identify gaps in health literacy knowledge, best practices, and preparedness to adapt on ERP implementation teams through three interrelated methods: in vivo observations of ERPs in-action at 4 Alabama facilities, extended semi-structured interviews of 120 stakeholders, and surveys measuring health literacy knowledge and organizational preparedness to adapt. Third, we will deliver the VISACT to two sites in Alabama (urban and rural) through a novel interactive response platform in a pilot study and assess for feasibility/acceptability through a RE-AIM framework of reach, efficacy, adoption, implementation, and maintenance measures. Acquired data will inform design of a multi-institutional stepped-wedge trial of the VISACT in the Deep South. Significance: This study will advance the NIH/NIMHD mission to eliminate surgical disparities and responds directly to the NIMHD Science Visioning Research Strategies by removing health literacy barriers (#24) and building the science of adapting interventions to different contexts (#30). Our team will furthermore (i) deliver the first health literate intervention in surgery, (ii) establish a novel implementation strategy (VISACT) to address surgical disparities and (iii) advance the science of interventions through adaptations.

项目摘要 基本原理：低健康素养影响了三分之一的手术人群，并且显着相关 手术结果较差。迫切需要减少大量人群中分布的干预措施。 我们的团队此前已经表明，增强的恢复计划（ERP）减轻手术中的种族分布 结果并提供了一种务实的方法来解决手术分布。但是，现有的ERP对 健康素养低的患者仍然会经历更差的结果。这个差距是由于缺乏拟合 当前的ERP和低健康素养患者的需求。通过K23，我们的团队评估了这些需求，并 制定了一种新颖的多级策略来改善拟合：让患者使用视觉辅助工具，教练提供者参与 沟通和培训健康素养的组织（VESACT）。现在有机会交付和 使用基于理论的适应框架测试视觉效果。成功的改编将改变现有 ERP并扩大对低健康素养人群的减少差异影响。目标：我们的长期 目的是通过通过 现有ERP的上下文驱动的改编。我们假设Visact将提高ERP的保真度 低健康素养患者的成分以及外科预后。为了实现我们的目标，我们的目标是： （SA1）确定ERP的健康素养敏感组成部分以增强visact，（SA2）评估 ERP团队提供者和组织单位的健康素养需求，（SA3）交付和试点测试 现有ERP的VISACT实施策略。方法：在动态适应过程的指导下 框架，我们将首先在大型ERP数据库（n> 7,000）上使用机器学习来识别健康素养 - ERP的敏感组件以visact（SA1）增强。其次，我们将使用收敛的混合 综合方法来识别健康素养知识，最佳实践和准备方面的差距 通过三种相互关联的方法适应ERP实施团队：在体内观察ERP 在阿拉巴马州的4个设施，扩展的半结构化访谈，对120个利益相关者进行调查，以衡量健康 识字知识和组织准备适应。第三，我们将将视觉ac送到两个地点 阿拉巴马州（城市和农村）通过试点研究和评估的新型互动响应平台 可行性/可接受性，通过重新启用，效率，采用，实施和 维护措施。获取的数据将为设计提供了一项多机构的跨跨跨试验试验 南部深处的visact。意义：这项研究将推进NIH/NIMHD的任务以消除外科手术 差异并通过消除健康直接回应NIMHD科学远景研究策略 扫盲障碍（＃24）并建立了将干预措施适应不同环境的科学（＃30）。我们的团队会 此外（i）在手术中提供了第一个健康识字干预，（ii）建立一种新颖的实施策略 （visact）解决手术差异和（iii）通过适应来推进干预措施的科学。