背景:患有慢性疾病并由医疗补助保险的人的治疗后结果差异有很好的记录,然而,缺乏减轻它们的干预措施。现行的过渡性护理干预措施狭窄地针对65岁及以上的人群,与特定的疾病过程,或有限地关注个体层面的行为改变,如自我护理或症状管理,因此,未能充分提供一个整体的方法,以确保一个最佳的后护理连续。本研究评估了THRIVE的实施情况-一种基于证据的方法,以公平为重点的临床路径,通过关注健康的社会决定因素以及医疗保健服务中的系统性和结构性障碍,支持从医院到家庭的多种慢性疾病的医疗补助保险个人。实质性服务包括协调护理,规范跨学科交流,并解决出院后未满足的临床和社会需求。
目的:本研究的目的是(1)检查转诊模式,重新接纳30天,与接受常规护理的参与者相比,接受THRIVE支持服务的参与者和急诊科的使用情况,以及(2)评估THRIVE临床路径的实施情况,包括保真度,可行性,适当性,和可接受性。
方法:我们将分3个步骤对研究医院的病例管理人员进行连续随机推出THRIVE(第一组为4,4在第二,和第三个中的5个),数据收集将在18个月内进行。参加THRIVE的纳入标准包括(1)参加Medicaid保险,双重参加了医疗补助和医疗保险,(2)居住在费城;(3)在研究医院住院超过24小时并计划出院回家;(4)同意在合作伙伴家庭护理环境中进行家庭护理;(5)年龄在18岁或以上。定性数据将包括对参与THRIVE的临床医生的访谈,和卫生服务使用的定量数据(即,重新接纳30天,急诊科使用,以及初级和专科护理)将来自电子健康记录。
结果:该项目于2023年1月获得资助,并于2023年3月10日获得机构审查委员会的批准。数据收集将于2023年3月至2024年7月进行。结果预计将于2025年公布。
结论:THRIVE临床路径旨在通过THRIVE参与者可接受的系统级干预来减少差距并改善Medicaid保险患者的出院后护理过渡,临床医生,以及他们在医院和家庭护理环境中的团队。通过使用我们以公平为重点的病例管理服务,并利用电子病历的强大功能,THRIVE通过识别高需求患者来提高效率,改善急性和社区部门之间的沟通,并推动循证护理协调。这项研究将增加关于在循证干预措施的设计和评估中注入以公平为中心的原则如何有助于实施和有效性结果的重要发现。
■DERR1-10.2196/54211。
背景:ClinicalTrials.govNCT05714605;https://clinicaltrials.gov/ct2/show/NCT05714605。
BACKGROUND: Disparities in posthospitalization outcomes for people with chronic medical conditions and insured by Medicaid are well documented, yet interventions that mitigate them are lacking. Prevailing transitional care interventions narrowly target people aged 65 years and older, with specific disease processes, or limitedly focus on individual-level behavioral change such as self-care or symptom management, thus failing to adequately provide a holistic approach to ensure an optimal posthospital care continuum. This
study evaluates the implementation of THRIVE-an evidence-based, equity-focused clinical pathway that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home by focusing on the social determinants of health and systemic and structural barriers in health care delivery. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge.
OBJECTIVE: The
study\'s objectives are to (1) examine referral patterns, 30-day readmission, and emergency department use for participants who receive THRIVE support services compared to those receiving usual care and (2) evaluate the implementation of the THRIVE clinical pathway, including fidelity, feasibility, appropriateness, and acceptability.
METHODS: We will perform a sequential randomized rollout of THRIVE to case managers at the
study hospital in 3 steps (4 in the first group, 4 in the second, and 5 in the third), and data collection will occur over 18 months. Inclusion criteria for THRIVE participation include (1) being Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) residing in Philadelphia; (3) having experienced a hospitalization at the
study hospital for more than 24 hours with a planned discharge to home; (4) agreeing to home care at partner home care settings; and (5) being aged 18 years or older. Qualitative data will include interviews with clinicians involved in THRIVE, and quantitative data on health service use (ie, 30-day readmission, emergency department use, and primary and specialty care) will be derived from the electronic health record.
RESULTS: This project was funded in January 2023 and approved by the institutional review board on March 10, 2023. Data collection will occur from March 2023 to July 2024. Results are expected to be published in 2025.
CONCLUSIONS: The THRIVE clinical pathway aims to reduce disparities and improve postdischarge care transitions for Medicaid-insured patients through a system-level intervention that is acceptable for THRIVE participants, clinicians, and their teams in hospitals and home care settings. By using our equity-focused case management services and leveraging the power of the electronic medical record, THRIVE creates efficiencies by identifying high-need patients, improving communication across acute and community-based sectors, and driving evidence-based care coordination. This
study will add important findings about how the infusion of equity-focused principles in the design and evaluation of evidence-based interventions contributes to both implementation and effectiveness outcomes.
UNASSIGNED: DERR1-10.2196/54211.
BACKGROUND: ClinicalTrials.gov NCT05714605; https://clinicaltrials.gov/ct2/show/NCT05714605.