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.

即使在 COVID-19 之前，肺炎伴呼吸衰竭也是住院的一个非常常见的原因。不幸的是，许多肺炎幸存者仍存在数月或数年的持续健康问题此后，该有效初级保健实践的目标是增强康复轨迹。肺炎（专家）研究后的目的是利用欣赏性询问来帮助初级保健顾客得到更好的护理肺炎患者在出院后 6 个月内的情况——通过采取基于优势的方法设计和测试新的系统级干预的转型变革。我们将使用多种方法对初级保健行动进行定量分析并进行定性分析与初级保健专家新人和患者的访谈被用于完善创新干预措施参与式原型试验的目标是与增加的机械过程结果相关。我们的团队来自初级保健、住院医学、重症监护、姑息治疗、脓毒症、信息学、临床流行病学、医学社会学和临床试验将：目标 1：定量分析精细的 EHR 数据，以识别和完善候选组件我们将利用大型、功能丰富的数据集进行初级保健干预，以改善肺炎后护理。从我们团队的 3 个不同的卫生系统中确定主要的具体订单、转诊和计费服务肺炎发生后 6 个月内的护理频率明显高于之前和时间目标 2：定性分析经验见解。初级保健新手和肺炎幸存者的识别和完善候选成分和确定肺炎后干预的推动因素和障碍。对 4 个州的 PCC 和肺炎幸存者进行访谈和焦点小组讨论，以评估关键行动和肺炎后成功康复的实施因素目标 3. 完善和试点小说。多组成部分初级保健干预措施，以改善肺炎后护理的提供，这将导致我们将采用一种新颖的利益相关者参与策略，改善肺炎幸存者的健康状况。参与式原型设计，迭代优化干预措施并评估其对目标机制的影响八位点集群随机试点试验设计的结果。 EXPERT 的研究解决了肺炎后护理这一公共卫生优先事项的基本知识差距。我们建议使用欣赏式询问来帮助初级保健做初级保健擅长的事情，并优化一种使他们更容易做到这一点的干预措施。