Effective Primary care practices that Enhance Recovery Trajectories after pneumonia (EXPERT)

增强肺炎后康复轨迹的有效初级保健实践（专家）

基本信息

批准号：
10717618
负责人：
Catherine Lee Hough
金额：
$ 76.16万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-15 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10717618
关键词：
Address Advance Care Planning COVID-19 Caring Clinical Trials Critical Care Data Data Set Disease Electronic Health Record Focus Groups Goals Health Health system Hospitalists Hospitalization Hospitals Informatics Intervention Interview Knowledge Link Malignant Neoplasms Measures Medical Sociology Medicine Methods Myocardial Infarction Outcome Palliative Care Patient-Focused Outcomes Patients Pharmaceutical Preparations Physical therapy Pneumonia Primary Care Process Randomized Recovery Research Respiratory Failure Sepsis Site Stroke Structure Survivors System Testing United States Work clinical epidemiology design experience follow-up hospital readmission implementation determinants improved improved outcome innovation insight intervention refinement long term recovery medical specialties novel pilot trial post-COVID-19 pragmatic randomized trial primary care clinician primary care practice primary care services primary care team process improvement prototype public health priorities trial design user centered design

项目摘要

Even before COVID-19, pneumonia with respiratory failure was a very common cause of hospitalization. Unfortunately, many patients who survive pneumonia have persistent health problems for months or years afterwards. The objective of this Effective Primary Care Practices that Enhance Recovery Trajectories after Pneumonia (EXPERT) study is to use appreciative inquiry to help primary care clinicians take better care of pneumonia patients in the 6 months after hospital–by taking a strengths-based approach for transformational change to design and test a new systems-level intervention. We will use a multi-methods approach wherein quantitative analysis of primary care actions and qualitative interviews with expert primary care clinicians and patients are used to refine an innovative intervention in a participatory prototyping pilot trial. The pilot trial targets mechanistic process outcomes linked to increased hospital-free days for pneumonia survivors. Our team from primary care, hospitalist medicine, critical care, palliative care, sepsis, informatics, clinical epidemiology, medical sociology, and clinical trials, will: Aim 1: Quantitatively analyze granular EHR data to identify and refine candidate components for a primary care intervention to improve post-pneumonia care. We will leverage large, feature-rich datasets from our team’s 3 diverse health systems to identify specific orders, referrals, and billing services by primary care clinicians that are substantially more frequent in the 6 months after pneumonia than before and temporally associated with reduced subsequent hospitalization. Aim 2: Qualitatively analyze the experiential insights of primary care clinicians and pneumonia survivors to identify and refine candidate components and identify enablers and barriers for the post-pneumonia intervention. We will conduct semi-structured interviews and focus groups with PCCs and pneumonia survivors across 4 states to evaluate key actions and implementation factors for successful post-pneumonia recovery. Aim 3. Refine and pilot a novel multicomponent primary care intervention to improve delivery of post-pneumonia care that will lead to improved health outcomes for pneumonia survivors. We will use a novel stakeholder-engaged strategy of participatory prototyping to iteratively optimize the intervention and evaluate its effects on target mechanistic outcomes in an eight-site cluster randomized pilot trial design. EXPERT’s research addresses a fundamental knowledge gap in post-pneumonia care, a public health priority. We propose to use appreciative inquiry to help primary care do what primary care does well, and to optimize an intervention that makes it easier for them to do so.

甚至在Covid-19之前，呼吸衰竭的肺炎都是住院的非常普遍的原因。不幸的是，许多在肺炎中生存的患者持续存在数月或数年的健康问题然后。这种有效的初级保健实践的目的是增强恢复轨迹肺炎（专家）研究是在使用感激的询问来帮助初级保健临床医生接受更好的护理住院后6个月内的肺炎患者 - 采取基于优势的方法变革性的变革，设计和测试新的系统级干预措施。我们将使用多方法方法，其中定量分析初级保健行动和定性接受专业的初级保健临床医生和患者的访谈用于完善对A的创新干预措施参与原型试验试验。试点试验目标机械过程结果与增加有关肺炎存活的无医院日。我们的团队来自初级保健，医院医学，重症监护，姑息治疗，败血症，信息，临床流行病学，医学社会学和临床试验，将： AIM 1：定量分析颗粒EHR数据以识别和完善A的候选成分初级保健干预措施以改善肺炎后护理。我们将利用大型，功能丰富的数据集从我们团队的3个潜水员卫生系统中识别主要的订单，推荐和计费服务随后在肺炎后的6个月内比以前且暂时更频繁的护理临床医生与随后的住院减少有关。目标2：定性分析专家见解初级保健临床医生和肺炎的生存，以识别和完善候选成分和确定后营养后干预的推动因素和障碍。我们将进行半结构化与PCC和肺炎表面访谈和焦点小组之间的四个州，以评估关键行动和成功恢复后成功后的实施因素。目标3。完善和飞行员一本小说多组分初级保健干预措施，以改善后营养后护理的交付，这将导致改善了肺炎存活的健康结果。我们将使用一种新颖的利益相关者参与的策略参与原型迭代优化干预措施并评估其对目标机械的影响在八个站点群集随机试点试验设计中的结果。专家的研究涉及公共卫生优先事项的pneumonia后护理方面的基本知识差距。我们建议使用欣赏性询问来帮助初级保健做得很好，并优化一种干预措施，使他们更容易这样做。