Zolnoori Maryam, McDonald Margaret V, Barrón Yolanda, Cato Kenrick, Sockolow Paulina, Sridharan Sridevi, Onorato Nicole, Bowles Kathryn, Topaz Maxim
School of Nursing, Columbia University, New York, NY, United States.
Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, United States.
JMIR Res Protoc. 2021 Jan 22;10(1):e20184. doi: 10.2196/20184.
Homecare settings across the United States provide care to more than 5 million patients every year. About one in five homecare patients are rehospitalized during the homecare episode, with up to two-thirds of these rehospitalizations occurring within the first 2 weeks of services. Timely allocation of homecare services might prevent a significant portion of these rehospitalizations. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an assessment of the patient's capacity for self-care, medication reconciliation, an examination of the home environment, and a discussion regarding whether a caregiver is present. Hence, appropriate timing of the first visit is crucial, especially for patients with urgent health care needs. However, nurses often have limited and inaccurate information about incoming patients, and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called Priority for the First Nursing Visit Tool (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits.
This study aims to evaluate the effectiveness of the PREVENT tool on process and patient outcomes and to examine the reach, adoption, and implementation of PREVENT.
Employing a pre-post design, survival analysis, and logistic regression with propensity score matching analysis, we will test the following hypotheses: compared with not using the tool in the preintervention phase, when homecare clinicians use the PREVENT tool, high-risk patients in the intervention phase will (1) receive more timely first homecare visits and (2) have decreased incidence of rehospitalization and have decreased emergency department use within 60 days. Reach, adoption, and implementation will be assessed using mixed methods including homecare admission staff interviews, think-aloud observations, and analysis of staffing and other relevant data.
The study research protocol was approved by the institutional review board in October 2019. PREVENT is currently being integrated into the electronic health records at the participating study sites. Data collection is planned to start in early 2021.
Mixed methods will enable us to gain an in-depth understanding of the complex socio-technological aspects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making through the use of cutting-edge technology and (2) improve patient outcomes in the understudied homecare setting.
ClinicalTrials.gov NCT04136951; https://clinicaltrials.gov/ct2/show/NCT04136951.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/20184.
美国各地的家庭护理机构每年为超过500万患者提供护理服务。在家庭护理期间，约五分之一的家庭护理患者会再次住院，其中多达三分之二的再次住院发生在服务的前两周内。及时分配家庭护理服务可能会避免很大一部分此类再次住院情况的发生。首次家庭护理访视是家庭护理过程中最关键的步骤之一。此次访视包括评估患者的自我护理能力、药物重整、检查家庭环境以及讨论是否有护理人员在场。因此，首次访视的恰当时间至关重要，尤其是对于有紧急医疗需求的患者。然而，护士通常对即将入院的患者信息掌握有限且不准确，并且护士之间的患者优先级决策差异很大。我们开发了一种创新的决策支持工具，称为首次护理访视优先级工具（PREVENT），以协助护士对需要立即进行首次家庭护理访视的患者进行优先级排序。
本研究旨在评估PREVENT工具对流程和患者结局的有效性，并考察PREVENT的覆盖范围、采用情况和实施情况。
采用前后对照设计、生存分析以及倾向得分匹配分析的逻辑回归，我们将检验以下假设：与干预前阶段不使用该工具相比，当家庭护理临床医生使用PREVENT工具时，干预阶段的高危患者将（1）更及时地接受首次家庭护理访视，并且（2）再次住院率降低，60天内急诊就诊次数减少。将使用混合方法评估覆盖范围、采用情况和实施情况，包括对家庭护理入院工作人员的访谈、出声思考观察以及对人员配置和其他相关数据的分析。
该研究方案于2019年10月获得机构审查委员会的批准。PREVENT目前正在参与研究的站点集成到电子健康记录中。数据收集计划于2021年初开始。
混合方法将使我们能够深入了解医院到家庭护理过渡的复杂社会技术方面。研究结果有可能（1）通过使用前沿技术影响护士决策的标准化和个性化，以及（2）改善在研究较少的家庭护理环境中的患者结局。
ClinicalTrials.gov NCT04136951；https://clinicaltrials.gov/ct2/show/NCT04136951。
国际注册报告识别码（IRRID）：PRR1 - 10.2196/20184。
