Transforming the Acute Care Environment: BWH PROSPECT Framework
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 4,368
- 试验地点
- 2
- 主要终点
- Preventable Harms (Adverse Events) in the Acute Care Setting
研究概览
简要总结
The purpose of this project is to refine, implement, and evaluate a multi-component intervention that achieves sustainable and meaningful impact on healthcare quality, safety, and costs while ensuring dignity and respect for adult oncology and intensive care patients and their care partners. The PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication, and Technology) framework will achieve this by enhancing the patient-provider relationship and introducing patient-centered approaches to multi-disciplinary communication and patient education. The PROSPECT framework is based upon a validated structured, team-work training model and novel web-based technology. The overarching goals of this project are to achieve the following:
- Optimize the overall experience of patients (including their family/care partners) by promoting dignity/respect, encouraging engagement, improving care plan concordance, and enhancing satisfaction.
- Minimize preventable harms in two environments: intensive care and acute care oncology units.
- Reduce unnecessary healthcare resource utilization and associated costs.
详细描述
This overarching project aims are to refine, implement, and evaluate a multi-faceted intervention composed of the Patient-SatisfActive® model, developed by Drs. Ronen Rozenblum and David Bates at Brigham and Women's Hospital, and a web-based Patient-Centered Toolkit (PCTK), developed by Drs. Dykes and Dalal, on quality, safety, and cost outcomes in the intensive care and oncology units at Brigham and Women's Hospital. The specific aims of the project are as follows:
- Aim 1: To refine and implement the Patient-SatisfActive® model to promote respect, dignity, and satisfaction of patients, care partners and staff on intensive care and oncology units.
- Aim 2: To refine and implement a web-based, Patient-Centered Toolkit (PCTK), comprised of an electronic bedside communication center (eBCC) and a patient-centered microblog, to promote tailored patient and care-partner education, communication, collaboration, and engagement.
- Aim 3: To evaluate the relative impact of this intervention compared to usual care on patient reported outcome measures, adverse events (harms), post-discharge healthcare utilization, concordance in understanding the care plan, and satisfaction among care team members (patients/care partners, profession providers).
- Aim 4: To identify the barriers and facilitators of implementing this intervention to support dissemination.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age > 18
- •Any patient admitted or transferred to designated care units
- •Admitted or transferred to a MICU or Oncology service
- •On the designated unit for at least 24 hours
排除标准
- •Age < 18
- •Any patient admitted or transferred to designated care unit but NOT on a MICU or Oncology service
结局指标
主要结局
Preventable Harms (Adverse Events) in the Acute Care Setting
时间窗: Enrolled patients will be followed for the duration of hospital stay, typically ranging from 5 to 30 days.
Preventable adverse events in the acute care setting include medication errors, patient falls, veno-thromboembolism, hospital acquired infection, central line related bloodstream infection, ventilator associated pneumonia, catheter associated urinary tract infection, newly acquired physical harm/injury. We will measure the rate of adverse events acquired from the time of admission to study units through hospital discharge. Using an adaptation of the Institute for Healthcare Improvement (IHI) Global Trigger Tool, we will randomly sample charts of enrolled patients from intervention and control units during the pre-intervention and post-intervention periods to identify adverse events. The length of hospital stay for patients admitted to medical intensive care and oncology units at our institution is variable, typically ranging from 5 to 30 days.
次要结局
- Perceptions of Communication/Collaboration(Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months)
- Patient Experience & Satisfaction & Engagement(At time of transfer/discharger from study unit and up to 45-days post-hospitalization)
- Dignity and Respect(At time of transfer/discharger from study unit and up to 45-days post-hospitalization)
- Healthcare Resource Utilization(From time of hospital admission through 30-days post-discharge)
- Care Plan Concordance(Approximately 48-72 hours after admission to study unit)
- Patient Safety Climate(Once during baseline (pre-intervention) and post-intervention periods, approximately 12 months)
研究者
David W. Bates, MD, MSc
Chief, Division of General Medicine
Brigham and Women's Hospital