Kershaw Colleen, Lurie Jon D, Brackett Charles, Loukas Elias, Smith Katie, Mullins Sarah, Gooley Christine, Borrows Melissa, Bardach Shoshana, Perry Amanda, Carpenter-Song Elizabeth, Landsman H Samuel, Pierotti Danielle, Bergeron Ericka, McMahon Erin, Finn Christine
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
Dartmouth College Geisel School of Medicine, Hanover, NH.
Ther Adv Infect Dis. 2022 Dec 26;9:20499361221142476. doi: 10.1177/20499361221142476. eCollection 2022 Jan-Dec.
Hospitalizations for serious infections requiring long-term intravenous (IV) antimicrobials related to injection drug use have risen sharply over the last decade. At our rural tertiary care center, opportunities for treatment of underlying substance use disorders were often missed during these hospital admissions. Once medically stable, home IV antimicrobial therapy has not traditionally been offered to this patient population due to theoretical concerns about misuse of long-term IV catheters, leading to discharges with suboptimal treatment regimens, lengthy hospital stays, or care that is incongruent with patient goals and preferences.
A multidisciplinary group of clinicians and patients set out to redesign and improve care for this patient population through a health care innovation process, with a focus on increasing the proportion of patients who may be discharged on home IV therapy. Baseline assessment of current experience was established through retrospective chart review and extensive stakeholder analysis. The innovation process was based in design thinking and facilitated by a health care delivery improvement incubator.
The components of the resulting intervention included early identification of hospitalized people who inject drugs with serious infections, a proactive psychiatry consultation service for addiction management for all patients, a multidisciplinary care conference to support decision making around treatment options for infection and substance use, and care coordination/navigation in the outpatient setting with a substance use peer recovery coach and infectious disease nurse for patients discharged on home IV antimicrobials. Patients discharged on home IV therapy followed routine outpatient parenteral antimicrobial therapy (OPAT) protocols and treatment protocols for addiction with their chosen provider.
An intervention developed through a design-thinking-based health care redesign process improved patient-centered care for people with serious infections who inject drugs.
在过去十年中，因注射吸毒而需要长期静脉注射抗菌药物治疗严重感染的住院人数急剧上升。在我们的农村三级医疗中心，在这些住院治疗期间，往往会错过治疗潜在物质使用障碍的机会。一旦患者病情稳定，由于理论上担心长期静脉导管的滥用，传统上不会为这类患者提供家庭静脉抗菌治疗，这导致患者出院时治疗方案不理想、住院时间延长，或者治疗与患者的目标和偏好不一致。
一组多学科临床医生和患者着手通过医疗创新过程重新设计并改善对这类患者的护理，重点是增加可接受家庭静脉治疗出院的患者比例。通过回顾性病历审查和广泛的利益相关者分析，对当前经验进行了基线评估。创新过程基于设计思维，并由一个医疗服务改进孵化器提供便利。
最终干预措施的组成部分包括早期识别注射吸毒且患有严重感染的住院患者、为所有患者提供积极的成瘾管理精神科咨询服务、支持围绕感染和物质使用治疗方案决策的多学科护理会议，以及在门诊环境中由物质使用同伴康复教练和传染病护士为接受家庭静脉抗菌治疗出院的患者提供护理协调/引导。接受家庭静脉治疗出院的患者遵循常规门诊胃肠外抗菌治疗（OPAT）方案以及与他们选择的医疗机构商定的成瘾治疗方案。
通过基于设计思维的医疗重新设计过程开发的一项干预措施改善了以患者为中心的对注射吸毒且患有严重感染患者的护理。
