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 每年为患者提供近 2800 万次院前紧急医疗服务 (EMS) 救护车 美国心脏协会认识到 EMS 在链条中的价值。 生存的重要性，但 EMS 的纳入需要在后勤方面对多个人员之间的沟通提出挑战 通常，院前服务提供者不了解自己的实践模式和患者结果。 浪费了从经验中学习的宝贵机会，同时无意中强化了次优护理。 提供有关临床实践和患者结果的反馈是一种简单而有效的干预措施， 我们将利用人因工程原理（以用户为中心的设计）来开发、 完善并实施一个可扩展的反馈系统，我们称之为“门户”。 反馈、非财务激励和当地冠军，通过以下方式检查对提供商行为的影响： 在心血管紧急情况下遵循指南的护理表现。 该应用程序描述了一个混合方法提案，该提案解决了 NHLBI 的主要优先事项，以改善患者的健康状况 通过开发和完善 EMS 提供商提供的门户反馈系统来提高健康水平 对胸痛患者进行急性心血管急救的具体目标是： 1) 检查 2）完善视觉界面 通过以用户为中心的设计实现自动化 EMS 反馈；以及 3) 检查可行性并完善 实施 PORTAL 干预措施，以支持后续试验的有效性 反馈干预。 该团队拥有独特的资格来实现这些目标，拥有护理过渡、医疗保健方面的专业知识 运筹学、生物医学信息学、人因工程学、实施科学、实用主义 试验设计、定性方法和急性护理医学。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)、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有以下疾病的患者的院前提供者开发一个自动反馈系统 采取以用户为中心的方法，将 EMS 提供者置于现场。 设计过程的中心将大大提高通过以下方式增强提供商活动的能力： 利用提供者和利益相关者的意见提供可扩展的反馈。 提供者的反馈创建了一个机制，通过以下方式提高院前护理的质量和安全性： 我们建议开展这项工作，为集群随机化做准备。 评估对提供者行为和患者结果影响的试验。