Статья

Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial

Claudia SpiesDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. [email protected]Nicolas PaulDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, GermanyChristine AdrionInstitute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Campus Grosshadern, Munich, GermanyElke BergerDepartment of Health Care Management, Technische Universität Berlin, Berlin, GermanyReinhard BusseDepartment of Health Care Management, Technische Universität Berlin, Berlin, GermanyBen KraufmannFraunhofer Institute for Open Communication Systems, Berlin, GermanyUrsula MarschallSimone RosseauWeaning- and Ventilation Centre, Ernst von Bergmann Klinik, Bad Belzig, GermanyClaudia DenkeDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, GermanyHenning KrampeDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, GermanyEnrico DähnertDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, GermanyUlrich MansmannInstitute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), Campus Grosshadern, Munich, GermanyBjörn WeißDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, GermanyERIC Study GroupMoritz F. AdamLucas AlbersNicolai AndreesStefan AngermairFelix BalzerSascha BartschSabine BechererSebastian Daniel BoieJan-Peter BraunFelix BuschAskin BüyüközerJörg CaumannsJonas CittadinoEva M. DüllmannAndreas EdelLisa EymoldCynthia S. FrankeGeorg FritzMartina GaßnerAlexander GeißlerMaximilian GoedeckeSusanne GörtzenJulius J. GrunowE. HärtungStefan HeidemannBeata HennigJulian HermAnja HeymannMoritz HöftJürgen JankeHans-Joachim JanssenMarc KastrupThomas KibatSascha KirstenRobin KleinwächterWilma KlinkTobias KlöpperAnna-C. KnautheJens-Peter KönigThomas KönigMax R. KrautzPhilipp LandgrafCarola LoockRalf LorenzAlexandr MelnikovBelinda MemmertMario MenkTobias MoormannLutz NibbeStephan NiemetzMichele OckenMichael OppertMareen PigorschChristian PilleIvo PoberingBirgit PuhlmannMelanie RahmelStephan-Matthias Reyle-HahnElena L. Ribet BuseSusanne RöberSteffen RohdeArne RöhrsMax RosenthalKerstin RoßbergKay RumschüßelUlf SanderC. SanftMaren SchmidtMaximilian SchmidtSebastian SchmidtMarc D. SchmittnerJulika SchönTorsten SchröderFranziska StaerckKarin SteineckeSascha TafelskiSascha TreskatschMarlies VoglerSteffen Weber‐CarstensDirk WeilandRenata Wojcik

2023en

ABI

Аннотация

PURPOSE: Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (ICUs) in Germany. METHODS: We conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with an expected ICU stay of ≥ 24 h. Twelve ICU clusters in Berlin and Brandenburg were randomly assigned to three sequence groups to transition from control (standard care) to the intervention condition (telemedicine). The quality improvement intervention consisted of daily telemedical rounds guided by eight German acute ICU care QIs and expert consultations. Co-primary effectiveness outcomes were patient-specific daily adherence (fulfilled yes/no) to QIs, assessed by a central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. This study is completed and registered with ClinicalTrials.gov (NCT03671447). RESULTS: Between September 4, 2018, and March 31, 2020, 1463 patients (414 treated on control, 1049 on intervention condition) were enrolled at ten clusters, resulting in 14,783 evaluated days. Two randomised clusters recruited no patients (one withdrew informed consent; one dropped out). The intervention, as implemented, significantly increased QI performance for "sedation, analgesia and delirium" (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395-8.358), "ventilation" (OR 2.248, 1.198-4.217), "weaning from ventilation" (OR 9.049, 2.707-30.247), "infection management" (OR 4.397, 1.482-13.037), "enteral nutrition" (OR 1.579, 1.032-2.416), "patient and family communication" (OR 6.787, 3.976-11.589), and "early mobilisation" (OR 3.161, 2.160-4.624). No evidence for a difference in adherence to "daily multi-professional and interdisciplinary clinical visits" between both conditions was found (OR 1.606, 0.780-3.309). Temporal trends related and unrelated to the intervention were detected. 149 patients died during their index ICU stay (45 treated on control, 104 on intervention condition). CONCLUSION: A telemedical quality improvement program increased adherence to seven evidence-based German performance indicators in acute ICU care. These results need further confirmation in a broader setting of regional, non-academic community hospitals and other healthcare systems.

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Идентификаторы

DOI: 10.1007/s00134-022-06949-x

Цитирования и источники

Цитирований: 3Использованных источников: 0

Показатели — AkademScholar