Adaption of the Transition of Care Model for Post-Discharge HIV-NCD care in Malawi

马拉维出院后艾滋病毒非传染性疾病护理的护理模式转变

• 批准号: 10750007
• 负责人: Cecilia Kanyama
• 金额: $ 19.29万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10750007
• 关键词: Address; Admission activity; Adopted; Adoption; Adult; Africa South of the Sahara; Area; Awareness; Behavioral; Caregivers; Caring; Cessation of life; Clinical; Communities; Community Outreach; Complex; Continuity of Patient Care; Control Groups; Data; Diabetes Mellitus; Discharge Plannings; Disease; Disease Management; Effectiveness; Enrollment; Evaluation; Focus Groups; Goals; HIV; Healthcare Systems; Heart failure; Home; Hospitalization; Hospitals; Hotlines; Human immunodeficiency virus test; Income; Individual; Inflammation; Inpatients; Intervention; Interview; Lead; Length of Stay; Malawi; Mediating; Meta-Analysis; Methods; Modeling; Nurses; Opportunistic Infections; Outcome; Outpatients; Participant; Patient Admission; Patient Care; Patient-Focused Outcomes; Patients; Persons; Pharmacists; Phase; Physician Assistants; Polypharmacy; Preparation; Research; Research Personnel; Resources; Role; Surveys; Viral; Virus; Visit; acceptability and feasibility; adverse outcome; antiretroviral therapy; burden of illness; cardiometabolism; clinical practice; community based care; comorbidity; cost; evidence base; experience; feasibility testing; follow-up; hospital readmission; hypertensive; implementation framework; implementation science; improved; innovation; integrated care; low and middle-income countries; mortality; neglect; outreach program; patient population; pilot test; posthospitalization care; programs; provider communication; readmission risk; recruit; research study

PROJECT SUMMARY Most hospitals in Low Middle-Income countries (LMICS) do not practice the discharge planning models shown in high-income settings (HICS) to avert adverse outcomes posthospitalization. In the absence of such integrated programs and an increment in the double burden of disease of HIV and NCDs, the mortality in people living with HIV(PWH) continues to be high post-hospitalization. The long-term goal is to improve discharge practices and linkage to care for PWH and NCDS and achieve dual control of both conditions. The objective of this R21 application is to adapt the Transitional care Mode based in HICS (TCM) for targeted use as a post-discharge intervention for adults hospitalized with comorbid HIV and NCDs in Malawi and evaluate the feasibility and acceptability of the adapted intervention in preparation for a larger implementation science evaluation. The rationale for the project, is that there is a high mortality post-hospitalization for PWH and NCDS, in part because of the lack of integrated discharge- related interventions to support care post-hospitalization. TCM is an evidence-based model in the U.S. adopted into clinical practice for diverse patient populations and demonstrated effectiveness in improving patient outcomes after discharge. This model can be useful if adapted to the context and resources available in LMICS, and feasibility tested for long-term adoption in the care of PWH and NCDs. This research study will explore three specific aims: 1. Adapt the TCM for PWH hospitalized with NCDs in Malawi. 2. Pilot test the adapted TCM with PWH admitted with NCDs. 3. Evaluate the feasibility, effectiveness and acceptability of the adapted intervention. For the first aim, through in-depth interviews (IDI) and focus groups discussions (FGDs) with HIV/NCD stakeholders, hospital staff, patients, and caregivers, we will develop the SOPs for an adapted TCM. For the second aim, we will enroll 62 consecutive adults hospitalized with HIV and known with at least one common HIV- cardiometabolic comorbidity (hypertensive urgency, heart failure, or diabetes,) and provide the adapted TCM. For the third aim, using mixed methods, FGDs and IDI to hospital staff and patient/caregivers who participated in TCM, we will evaluate the feasibility of providing TCM for a larger study. We will describe 3-month post-discharge outcomes including re-admission, linkages and retention in care, mortality, and dual control of HIV and NCDs. Comparison with a historical control group recruited just prior to the pilot phase will provide preliminary data in regard to potential effects on readmission and death. This project is innovative in that it will adapt a known model of transitional care from HICS to LMICS for PWH/NCDS using existing resources to avert adverse outcomes. It will reinforce integrated linkages to care for both HIV/NCDs. The proposed research is significant because it represents a new effort to bridge the gap between inpatient and community-based care and integrate the care of HIV/NCDs posthospitalization.

项目摘要 低中等收入国家（LMIC）的大多数医院都不练习出院计划模型 在高收入设置（HIC）中显示，以避免遗产后的不利结果。在没有 这种综合计划以及艾滋病毒和NCD疾病的双重负担的增长， 艾滋病毒（PWH）患者的死亡率继续是高院后的高度。长期目标是 改善出院惯例和链接以照顾PWH和NCD，并双方对两者进行双重控制 状况。此R21应用的目的是调整基于HIC的过渡护理模式 （TCM）针对患有合并症HIV住院的成年人的针对性用作用于分期的干预措施 马拉维的NCD并评估适应性干预措施的可行性和可接受性 进行更大的实施科学评估。该项目的理由是 PWH和NCD的院后死亡率，部分原因是缺乏综合排放 - 相关的干预措施以支持医疗后的护理。 TCM是美国的基于证据的模型 通过用于多样化患者人群的临床实践，并在 出院后改善患者预后。如果适应上下文，并且该模型可能很有用 LMIC中可用的资源，并在PWH和NCD的护理中测试了长期采用的可行性。 这项研究将探讨三个具体目标：1。适应NCDS住院的PWH的TCM 在马拉维。 2。试点用NCD接纳的PWH测试适用的TCM。 3。评估可行性， 改编干预的有效性和可接受性。对于第一个目标，深入 访谈（IDI）和焦点小组讨论（FGD）与HIV/NCD利益相关者，医院工作人员，患者， 和护理人员，我们将开发适合TCM的SOP。为了第二个目标，我们将注册62 连续患有艾滋病毒的成年人，至少有一个常见的HIV - 心脏代谢 合并症（高血压，心力衰竭或糖尿病），并提供适应性的TCM。为了 第三目的是使用混合方法，FGD和IDI给医院的工作人员以及参加的患者/护理人员 在TCM中，我们将评估提供TCM进行更大研究的可行性。我们将描述3个月 放电后的结果，包括重新入院，联系和保留率，死亡率和双重 艾滋病毒和NCD的控制。与飞行员之前招募的历史对照组的比较 阶段将提供有关潜在对再入院和死亡的潜在影响的初步数据。这个项目 具有创新性，因为它将适应已知的从HIC到LMIC的已知过渡模型 使用现有资源来避免不利的结果。它将加强集成的链接以照顾两者 HIV/NCD。拟议的研究很重要，因为它代表了弥合差距的新努力 在住院和基于社区的护理之间，并整合艾滋病毒/NCD的护理后培育道。