Alghanim Fahid, Furqan Muhammad, Prichett Laura, Landon Jondavid, Tao Xueting, Selvam Pooja, Leslie Myles, Hartman-Shea Katherine, Teague Paula, Scott Wayman, Kraeuter Susan, Hicks Heather, Jain Sneha, York Sarah, Blanding Renee, Zakaria Sammy
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Crit Care Explor. 2021 Nov 8;3(11):e0574. doi: 10.1097/CCE.0000000000000574. eCollection 2021 Nov.
To assess the effectiveness of a chaplain patient navigator in improving outcomes and reducing costs in the ICU setting.
A randomized controlled trial at a large, urban, academic community hospital in Baltimore, Maryland.
SETTING/PATIENTS: All patients admitted to the Johns Hopkins Bayview Medical Center Cardiac and Medical ICUs between March 2015 and December 2015.
Patients in the intervention group were assigned a chaplain patient navigator to facilitate communication, offer support, and setup multidisciplinary family meetings.
The primary outcomes were hospital and ICU length of stay. Secondary outcomes included total and ICU charges, 60- and 90-day readmission rates, and the number of palliative care consults. For all outcomes, patients were included in the intention-to-treat analyses only if they remained in the ICU greater than 24 hours. In total, 1,174 were randomly assigned to "usual care" ( = 573) or to the intervention ( = 601). In the intervention group, 44.8% (269/601) had meetings within 24 hours of admission and, of those patients, 32.8% (88/268) took part in the larger multidisciplinary family meeting 2-3 days later. The intervention group had longer mean adjusted hospital length of stay (7.78 vs 8.63 d; ≤ 0.001) and mean ICU length of stay (3.65 vs 3.87 d; = 0.029). In addition, they had greater total and ICU charges. There were no differences in other outcomes. Of note, only differences in total and ICU charges remained when controlling for case-mix index, which were greater in the intervention group.
Although the chaplain patient navigator anecdotally enhanced communication, our study found an increase in hospital and ICU length of stay as well as cost. Since other studies have shown benefits in some clinical outcomes, projects focused on patient navigators may learn lessons from our study in order to better prioritize family meetings, gather indicators of communication quality, and identify the optimal patient navigator operational context.
评估神职人员患者导航员在改善重症监护病房（ICU）环境下的治疗效果及降低成本方面的有效性。
在马里兰州巴尔的摩市一家大型城市学术社区医院进行的随机对照试验。
地点/患者：2015年3月至2015年12月期间入住约翰霍普金斯湾景医疗中心心脏科和内科重症监护病房的所有患者。
为干预组患者分配一名神职人员患者导航员，以促进沟通、提供支持并组织多学科家庭会议。
主要结局指标为住院时间和ICU住院时间。次要结局指标包括总费用和ICU费用、60天和90天再入院率以及姑息治疗会诊次数。对于所有结局指标，仅当患者在ICU停留超过24小时时才纳入意向性分析。总共1174例患者被随机分配至“常规护理”组（n = 573）或干预组（n = 601）。在干预组中，44.8%（269/601）的患者在入院后24小时内召开了会议，其中32.8%（88/268）的患者在2 - 3天后参加了规模更大的多学科家庭会议。干预组调整后的平均住院时间更长（7.78天对8.63天；P≤0.001），平均ICU住院时间也更长（3.65天对3.87天；P = 0.029）。此外，干预组的总费用和ICU费用更高。其他结局指标无差异。值得注意的是，在控制病例组合指数后，仅总费用和ICU费用存在差异，且干预组的差异更大。
尽管神职人员患者导航员在改善沟通方面有一定作用，但我们的研究发现住院时间和ICU住院时间以及成本均有所增加。鉴于其他研究在某些临床结局方面显示出益处，专注于患者导航员的项目可能会从我们的研究中吸取经验教训，以便更好地安排家庭会议的优先级、收集沟通质量指标并确定最佳的患者导航员操作环境。
