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首页> 外文期刊>BMC Health Services Research >The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool
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The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool

机译：无缝护理转移方案：随机对照试验评估电子护理通信工具的功效

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Background The transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients’ medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer. This study examines whether a transfer-of-care (TOC) communication tool is efficacious and cost-effective for reducing hospital readmission, adverse events and adverse drug events as well as reducing death. Methods A randomized controlled trial conducted on the Medical Teaching Unit of a Canadian tertiary care centre will evaluate the efficacy and cost-effectiveness of a TOC communication tool. Medical in-patients admitted to the unit will be considered for this study. Data will be collected upon admission, and a total of 1400 patients will be randomized. The control group’s acute care stay will be summarized using a traditional dictated summary, while the intervention group will have a summary generated using the TOC communication tool. The primary outcome will be a composite, at 3 months, of death or readmission to any Alberta acute-care hospital. Secondary outcomes will be the occurrence of post-discharge adverse events and adverse drug events at 1 month post discharge. Patients with adverse outcomes will have their cases reviewed by two Royal College certified internists or College-certified family physicians, blinded to patients’ group assignments, to determine the type, severity, preventability and ameliorability of all detected adverse outcomes. An accompanying economic evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries. Discussion This paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation. Trial registration ClinicalTrials.gov NCT01402609.
机译：背景技术急性护理和社区关怀之间的过渡代表了医疗保健交付的脆弱期。这一时期的脆弱性归因于住院期间对患者药物治疗方案的变化，未能在入院和排放之间调和差异以及患者/家庭的负担，以接管院外的护理责任，并将重要信息转发给初级保健医师。电子通信平台可以在急性护理和社区护理医生（和其他社区提供商）之间提供即时联系，旨在确保一致的信息传输。本研究探讨了护理转移（TOC）通信工具是否对减少医院入院，不良事件和不良药物事件以及降低死亡的有效和成本效益。方法对加拿大三级护理中心的医学教学单元进行随机对照试验，将评估TOC通信工具的功效和成本效益。将考虑参加本机的医疗患者，将考虑本研究。将在入场时收集数据，共有1400名患者将随机化。控制组的急性护理住宿将总结使用传统的规定摘要，而干预组将使用TOC通信工具产生摘要。主要结果将是综合，3个月，死亡或入院任何艾伯塔省急性护理医院。二次结果将发生在1个月后排放后发后不良事件和不良药物事件的发生。不良成果的患者将由两名皇家学院认证的内科医生或大学认证的家庭医生审查的案件，对患者的群体作业蒙蔽，以确定所有检测到的不利结果的类型，严重程度，预防性和可加素。随附的经济评估将评估保存的每年的成本，避免了每次即将到来的成本，并且与TOC通信工具获得的每次QALY成本相比，与传统听说摘要相比。讨论本文概述了随机对照试验的研究方案，评估了电子传送通信工具，具有足够的统计能力，以评估工具对出院后死亡或入院的显着结果的影响。研究结果将在世界各地的卫生系统上为这些工具的潜在利益提供信息，以及与其广泛实施的金额的价值。试验登记ClinicalTrials.gov NCT01402609。

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