Alberta Health Services, Edmonton & Calgary, AB, Canada.
Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, AB, T6G2X8, Canada.
BMC Health Serv Res. 2020 Jun 18;20(1):558. doi: 10.1186/s12913-020-05427-8.
Liver cirrhosis is a leading cause of morbidity, premature mortality and acute care utilization in patients with digestive disease. In the province of Alberta, hospital readmission rates for patients with cirrhosis are estimated at 44% at 90 days. For hospitalized patients, multiple care gaps exist, the most notable stemming from i) the lack of a structured approach to best practice care for cirrhosis complications, ii) the lack of a structured approach to broader health needs and iii) suboptimal preparation for transition of care into the community. Cirrhosis Care Alberta (CCAB) is a 4-year multi-component pragmatic trial which aims to address these gaps. The proposed intervention is initiated at the time of hospitalization through implementation of a clinical information system embedded electronic order set for delivering evidence-based best practices under real-world conditions. The overarching objective of the CCAB trial is to demonstrate effectiveness and implementation feasibility for use of the order set in routine patient care within eight hospital sites in Alberta.
A mixed methods hybrid type I effectiveness-implementation design will be used to evaluate the effectiveness of the order set intervention. The primary outcome is a reduction in 90-day cumulative length of stay. Implementation outcomes such as reach, adoption, fidelity and maintenance will also be evaluated alongside other patient and service outcomes such as readmission rates, quality of care and cost-effectiveness. This theory-based trial will be guided by Normalization Process Theory, Consolidated Framework on Implementation Research (CFIR) and the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) Framework.
The CCAB project is unique in its breadth, both in the comprehensiveness of the multi-component order set and also for the breadth of its roll-out. Lessons learned will ultimately inform the feasibility and effectiveness of this approach in "real-world" conditions as well as adoption and adaptation of these best practices within the rest of Alberta, other provinces in Canada, and beyond.
ClinicalTrials.gov: NCT04149223, November 4, 2019.
肝硬化是导致消化疾病患者发病率、过早死亡和急性护理利用的主要原因。在艾伯塔省，肝硬化患者的 90 天再入院率估计为 44%。对于住院患者，存在多种护理差距，最值得注意的是：i）缺乏针对肝硬化并发症的最佳实践护理的结构化方法，ii）缺乏针对更广泛健康需求的结构化方法，以及 iii）对护理过渡到社区的准备不足。肝硬化护理艾伯塔省（CCAB）是一项为期 4 年的多组成分实用试验，旨在解决这些差距。该干预措施在住院时开始实施，通过实施临床信息系统，嵌入电子医嘱集，在实际情况下提供循证最佳实践。CCAB 试验的总体目标是证明在艾伯塔省的八个医院站点中，在常规患者护理中使用医嘱集的有效性和实施可行性。
将使用混合方法混合 I 型有效性实施设计来评估医嘱集干预措施的有效性。主要结果是减少 90 天累积住院时间。还将评估实施结果，如可达性、采用、保真度和维持，以及其他患者和服务结果，如再入院率、护理质量和成本效益。该基于理论的试验将由正常化过程理论、实施研究综合框架（CFIR）和可达性-有效性-采用-实施-维持（RE-AIM）框架指导。
CCAB 项目在其广度上是独一无二的，无论是多组成分医嘱集的全面性，还是其推广的广泛性。经验教训最终将为这种方法在“真实世界”条件下的可行性和有效性以及这些最佳实践在艾伯塔省其他地区、加拿大其他省份乃至其他地区的采用和适应提供信息。
ClinicalTrials.gov：NCT04149223，2019 年 11 月 4 日。
