Health IT generated PROs to Improve Outcomes in Cirrhosis

健康 IT 生成 PRO 来改善肝硬化的治疗结果

基本信息

批准号：
10374779
负责人：
Jasmohan S Bajaj
金额：
$ 39.46万
依托单位：
VIRGINIA COMMONWEALTH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-06-11 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10374779
关键词：
Health generated PROs Improve Outcomes

项目摘要

Patients with cirrhosis are prone to clinical and psycho-social issues that manifest as patient-reported outcomes (PRO), which can independently predict hospitalization, re-hospitalizations and death. Our group has studied the impact of these PRO extensively. With the increasing spread of health-related electronic devices, the relevance of health IT in the management of chronic diseases such as cirrhosis is paramount. The team has already developed and used several health IT advances to educate patients and their caregivers in inpatient and outpatient settings. These tools include Patient Buddy to prevent avoidable readmissions and EncephalApp Stroop to detect and guide therapy for cognitive dysfunction in cirrhosis. However the evaluation of these tools in a multi-center study that adapts to the status of the patients and their caregivers is required. The central hypothesis is that cirrhotic patients randomized to health IT interventions that elicit PROs in a structured outpatient setting will have a significantly greater reduction in hospital readmissions because of improved communication with their medical teams compared to standard of care regardless of scheduled return outpatient visits. This will be tested using the following two specific aims in three centers (Virginia Commonwealth University, Richmond VA Medical Center and Mayo Clinic). Specific Aim 1: To evaluate in a multi-center, randomized trial the effectiveness of PROs elicited using PatientBuddy and EncephalApp with and without scheduled outpatients return visits on the prevention of avoidable 30 day readmissions in patients with cirrhosis and their caregivers compared to standard of care. We will include 450 total cirrhotic patients and 450 caregivers (150 patients and 150 caregivers per center), who will be followed for 30 days post-discharge. The groups will be randomized 1:1:1 into a standard of care group, a group receiving health IT interventions who will receive PatientBuddy and EncephalApp with as-needed follow-up and another group that receives the same health IT interventions along with scheduled outpatient visits and calls within 30 days of discharge. Avoidable readmissions will be adjudged using a blinded adjudication committee and the differences between the three groups will be compared. Specific aim 2: To incorporate the opinion of key stakeholders (patients, caregivers and nurse managers) towards improving the Patient Buddy App in the prevention of readmission in cirrhosis. As part of this trial, we will also elicit feedback regarding the ease, safety and personal effectiveness of these interventions as well as their personal comfort and educational value of the App with and without the scheduled outpatient follow-up, from the patients, caregivers and administering staff. This will be compared between centers and used to enhance the Patient Buddy App in collaboration with our technology partners. The updated App will then be available for future studies in larger cirrhosis populations.

肝硬化患者容易出现临床和心理社会问题，表现为患者报告的结果（PRO），可以独立预测住院、再住院和死亡。我们组广泛研究了这些 PRO 的影响。随着与健康相关的电子产品的日益普及设备，卫生信息技术在肝硬化等慢性疾病管理中的相关性至关重要。这团队已经开发并使用了多项健康信息技术进步来教育患者及其护理人员住院和门诊环境。这些工具包括患者伙伴，以防止可避免的再次入院和 EncephalApp Stroop 用于检测和指导肝硬化认知功能障碍的治疗。然而评价需要在多中心研究中使用这些工具来适应患者及其护理人员的状况。核心假设是，肝硬化患者随机接受健康 IT 干预，从而在以下方面引发 PRO：结构化的门诊环境将显着减少再入院率因为与标准护理相比，与医疗团队的沟通得到了改善无论预约的门诊回访情况如何。这将使用以下两个具体目标进行测试三个中心（弗吉尼亚联邦大学、里士满退伍军人医疗中心和梅奥诊所）。具体目标 1：在多中心、随机试验中评估使用以下方法引发的 PRO 的有效性 PatientBuddy 和 EncephalApp 定期或不定期门诊患者就预防进行回访与标准相比，肝硬化患者及其护理人员可避免的 30 天再入院率的照顾。我们将纳入 450 名肝硬化患者和 450 名护理人员（每个项目 150 名患者和 150 名护理人员）中心），出院后将对其进行 30 天的跟踪。各组将按 1:1:1 随机分配到标准组中护理小组，接受健康 IT 干预的小组，他们将接受 PatientBuddy 和 EncephalApp 按需跟进，另一组接受相同的健康 IT 干预措施以及预定的出院后 30 天内门诊就诊和打电话。可避免的再入院将通过盲法来判断评审委员会将比较三组之间的差异。具体目标 2：纳入主要利益相关者（患者、护理人员和护士）的意见管理人员）致力于改进 Patient Buddy 应用程序，以预防肝硬化患者再次入院。作为作为本次试验的一部分，我们还将征求有关这些工具的易用性、安全性和个人有效性的反馈干预措施以及个人舒适度和应用程序的教育价值（有或没有预定）来自患者、护理人员和管理人员的门诊随访。这将在之间进行比较中心，并用于与我们的技术合作伙伴合作增强 Patient Buddy 应用程序。这更新后的应用程序将可用于未来对更大肝硬化人群的研究。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Stool microbiota show greater linkages with plasma metabolites compared to salivary microbiota in a multinational cirrhosis cohort.

在多国肝硬化队列中，与唾液微生物群相比，粪便微生物群与血浆代谢物的联系更大。

DOI：
发表时间：
2022-10
期刊：
影响因子：
0
作者：
Cox, Isobel Jane;Peña Rodríguez, Marcela;Fagan, Andrew;Rojas;Le Guennec, Adrien;Rodriguez;McGeorge, Sara;Escalona;Torre, Aldo;Bajaj, Jasmohan S
通讯作者：
Bajaj, Jasmohan S

Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions.

肝硬化住院患者的营养评估可以在培训后得到改善，并且与降低再入院率相关。

DOI：
发表时间：
2019
期刊：
影响因子：
0
作者：
Reuter, Bradley;Shaw, Jawaid;Hanson, Jennifer;Tate, Victoria;Acharya, Chathur;Bajaj, Jasmohan S
通讯作者：
Bajaj, Jasmohan S

Sex is associated with differences in gut microbial composition and function in hepatic encephalopathy.

性别与肝性脑病肠道微生物组成和功能的差异有关。

DOI：
发表时间：
2021
期刊：
影响因子：
25.7
作者：
Saboo, Krishnakant;Shamsaddini, Amirhossein;Iyer, Mihir V;Hu, Chang;Fagan, Andrew;Gavis, Edith A;White, Melanie B;Fuchs, Michael;Heuman, Douglas M;Sikaroodi, Masoumeh;Iyer, Ravishankar K;Gillevet, Patrick M;Bajaj, Jasmohan S
通讯作者：
Bajaj, Jasmohan S

Perspectives of Inpatients With Cirrhosis and Caregivers on Using Health Information Technology: Cross-sectional Multicenter Study.

肝硬化住院患者和护理人员对使用健康信息技术的看法：横断面多中心研究。

DOI：
发表时间：
2021
期刊：
影响因子：
7.4
作者：
Acharya, Chathur;Sehrawat, Tejasav S;McGuire, Deborah B;Shaw, Jawaid;Fagan, Andrew;McGeorge, Sara;Olofson, Amy;White, Melanie B;Gavis, Edith;Kamath, Patrick S;Bergstrom, Lori;Bajaj, Jasmohan Singh
通讯作者：
Bajaj, Jasmohan Singh

Cognition and hospitalizations are linked with salivary and faecal microbiota in cirrhosis cohorts from the USA and Mexico.

在美国和墨西哥的肝硬化患者中，认知和住院治疗与唾液和粪便微生物群有关。

DOI：
发表时间：
2020
期刊：
影响因子：
0
作者：
Bajaj, Jasmohan S;Torre, Aldo;Rojas, Mayra L;Fagan, Andrew;Nandez, Ivvone E;Gavis, Edith A;De Leon Osorio, Omar;White, Melanie B;Fuchs, Michael;Sikaroodi, Masoumeh;Gillevet, Patrick M
通讯作者：
Gillevet, Patrick M