Baxter Ruth, Murray Jenni, O'Hara Jane K, Hewitt Catherine, Richardson Gerry, Cockayne Sarah, Sheard Laura, Mills Thomas, Lawton Rebecca
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.
School of Healthcare, University of Leeds, Leeds, UK.
Pilot Feasibility Stud. 2020 Sep 2;6:123. doi: 10.1186/s40814-020-00655-5. eCollection 2020.
Patients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The 'Your Care Needs You' (YCNY) intervention supports patients to 'know more' and 'do more' whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home.
As part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT.Ten acute hospital wards (the clusters) from varying medical specialties including older peoples' medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records.Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT.
This study will establish the feasibility of the YCNY intervention which aims to improve safety and experience during transitions of care. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of the YCNY intervention in a definitive cluster randomised controlled trial.
UK Clinical Research Network Portfolio: 42191; ISTCRN: ISRCTN51154948. Registered 16/07/2019.
患者，尤其是老年人，在从医院过渡到家庭的过程中经常会遇到安全问题。尽管目前关于如何改善这种护理过渡的证据并不明确，但支持患者参与的干预措施可能更有效。“你的护理需要你”（YCNY）干预措施旨在帮助患者在住院期间“了解更多”并“做得更多”，以便他们更好地了解自己的健康状况和药物，维持日常活动，并在需要时在家中寻求帮助。该干预措施旨在减少医院急诊再入院率，并改善过渡到家庭期间的安全性和体验。
作为“护理过渡伙伴”（PACT）研究计划的一部分，将进行一项多中心整群随机对照试验（cRCT），以探索YCNY干预措施和试验方法的可行性。数据将用于完善干预措施，并为确定性cRCT制定方案。来自不同医学专科的10个急性医院病房（整群），包括老年医学、创伤与骨科、心脏病学、中级护理和中风科室，将按3:2的比例随机分配以提供YCNY干预或常规护理。将招募多达200名75岁及以上且出院后回家的患者参与该研究。患者将在出院后5天、30天和90天完成随访问卷，并从其病历中提取出院后90天内的再入院数据。研究结果将包括可行性指标（如筛查、招募和保留数据）以及在患者和病房层面收集常规数据所需的流程。此外，将对多达24名患者/护理人员和28名工作人员进行访谈和观察，以定性评估干预措施和实施方案对患者和工作人员的可接受性、有用性和可行性。将进行一项单独的子研究，以探索在确定性cRCT中收集主要结局数据（30天急诊再入院率）的准确性。
本研究将确定YCNY干预措施的可行性，该措施旨在改善护理过渡期间的安全性和体验。它将识别在确定性整群随机对照试验中评估YCNY干预措施有效性之前需要解决的关键方法学和实施问题。
英国临床研究网络项目：42191；ISTCRN：ISRCTN51154948。2019年7月16日注册。
