Michigan Emergency Department Improvement Collaborative AltERnaTives to admission for Pulmonary Embolism (MEDIC ALERT PE) Study

密歇根急诊科改进合作入院肺栓塞 (MEDIC ALERT PE) 研究

基本信息

批准号：
10584217
负责人：
Geoffrey Douglas Barnes
金额：
$ 70.82万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
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：
2023-01-01 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10584217
关键词：
Accident and Emergency department Acute Address Adherence Admission activity Adoption Adverse event Ambulatory Care American Anticoagulants Behavioral Sciences Caring Clinical Conflict (Psychology)Data Collection Decision Making Development Diagnosis Disparity Effectiveness Electronics Elements Emergency Department patient Emergency Medicine Ensure Environment Ethnic Origin Evaluation Guidelines Health Care Costs Health Resources Health system Healthcare Hemorrhage Home Hospitalization Hospitals Hybrids Infrastructure Insurance Coverage Intervention Interview Lead Life Link Literature Maintenance Maps Measures Methodology Michigan Morbidity - disease rate Oral Outcome Outpatients Pathway interactions Patient Discharge Patient Preferences Patients Pharmaceutical Preparations Positioning Attribute Process Publishing Pulmonary Embolism Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Resources Retinal blind spot Risk Rural Safety Site Specific qualifier value Testing Theory of Change United States behavior change behavioral economics care delivery clinical decision-making clinical practice design effectiveness study evidence base evidence based guidelines experience follow-up heuristics implementation determinants implementation efforts implementation evaluation implementation framework implementation intervention implementation outcomes implementation protocol implementation science implementation strategy implementation trial improved improved outcome interest mortality multi-component intervention patient oriented patient safety point of care primary outcome program dissemination programs safety outcomes sex suburb success supplemental oxygen theories user centered design

项目摘要

PROJECT SUMMARY Of the 250,000 annual patients in the United States with acute pulmonary embolism (PE), the majority are at low risk for morbidity and mortality. In fact, evidence-based guidelines suggest that up to 50% of patients with an acute PE are at sufficiently low risk for complications that they can be safely managed without hospital admission. Yet fewer than 5% of patients nation-wide are currently discharged for outpatient management. Reliable access to anticoagulant medications and outpatient follow-up are commonly cited barriers to outpatient management. However, prevailing heuristics used by Emergency Medicine clinicians to enable rapid decision-making also firmly link acute PE with hospital admission, and likely makes behavior change for these busy clinicians more challenging. Multiple prior efforts to reduce hospital admission for low-risk patients with acute PE have been limited by single-center designs, inclusion of homogenous and highly-resourced health systems, or have lacked a robust implementation plan underpinning to their design and evaluation. Using the diverse, state-wide Michigan Emergency Department Improvement Collaborative (MEDIC), we will refine, tailor, and evaluate a multi-component intervention suitable for broad dissemination to increase the use of outpatient management of low-risk acute PE for patients presenting to the emergency department. Following an implementation mapping approach built upon published literature and our preliminary findings, our intervention will address key barriers identified by a diverse group of stakeholders by combining traditional implementation science and behavioral economics strategies. Importantly, electronic alerts will be informed by user-centered design approaches to fit within the clinician workflow and decision-making process and “right sized” to appear only for applicable patients. Evaluation will include both quantitative and qualitative elements from the RE-AIM implementation evaluation framework. This multi-component intervention will facilitate a patient-centered approach to clinical decision-making that improves value by reducing unnecessary hospitalization for patients with low-risk PE. Furthermore, by tailoring and evaluating this intervention within a diverse set of hospitals, our multi-component intervention will be well positioned for dissemination nation-wide. Finally, our use of multi-site implementation mapping will provide a blueprint for other multi-site collaboratives interested in improving outcomes for a broad array of clinical conditions through rigorous quality improvement and implementation initiatives.

项目概要美国每年有 250,000 名急性肺栓塞 (PE) 患者，其中大多数处于发病率和死亡率风险较低事实上，基于证据的指南表明高达 50% 的患者患有此病。急性肺栓塞发生并发症的风险足够低，无需住院即可安全治疗然而，目前全国只有不到 5% 的患者出院接受门诊治疗。可靠地获得抗凝药物和门诊随访是常见的障碍然而，急诊医学顾客普遍使用启发法来实现快速治疗。决策也将急性肺栓塞与入院紧密联系起来，并可能使这些人的行为发生改变此前多次努力减少低风险患者的入院率。急性肺栓塞受到单中心设计、同质和资源丰富的健康的限制系统，或者缺乏支持其设计和评估的强有力的实施计划。多元化、全州范围的密歇根急诊部改进合作组织 (MEDIC)，我们将完善、定制并评估适合广泛传播的多成分干预措施，以增加使用对到急诊科就诊的患者进行低风险急性肺栓塞的门诊管理。基于已发表的文献和我们的初步发现的实施映射方法，我们的干预措施将通过结合传统的方法来解决不同利益相关者群体发现的主要障碍重要的是，电子警报将由实施科学和行为经济学策略通知。以用户为中心的设计方法，以适应临床医生的工作流程和决策过程以及“正确的” 大小”仅针对适用的患者出现评估将包括定量和定性要素。 RE-AIM 实施评估框架的这一多组成部分干预措施将促进以患者为中心的临床决策方法，通过减少不必要的干预来提高价值低风险肺栓塞患者的住院治疗。此外，通过在一定范围内调整和评估这种干预措施我们的多组成部分干预措施由多元化的医院组成，将能够在全国范围内传播。最后，我们对多站点实施映射的使用将为其他多站点协作提供蓝图有兴趣通过严格的质量改进来改善各种临床状况的结果及实施建议。