Smart Discharges Transition to Scale
收藏资源简介：
<br /><strong>Dataset Description:</strong> This dataset contains materials from a the Smart Discharges Transition to Scale parent study within the <a href = "https://bcchr.ca/smart-discharges">Smart Discharges</a> program of research. Materials include the parent study protocol and associated documents. See the Metadata section below for links to related publications and datasets.<br /> <br /><strong>Background:</strong> In Uganda, approximately 5% of children admitted with severe infections die after they have been discharged from the hospital, mostly at home. Most of these deaths are preventable as they are largely due to the way that discharges are done and how follow-ups are planned. Health workers and caregivers are often unaware of this period of vulnerability and are poorly equipped to identify and handle this critical situation. Our previous work focused on developing and evaluating models and technology to predict, before discharge, an individual child’s risk of recurrent illness, as well as to provide additional post-discharge support to at-risk children. The goal of this project is to determine how best to scale the Smart Discharges Program through a four-phased approach, each corresponding to a specific objective. <strong>Phase I :</strong> aims to understand the reasons for suboptimal discharge by evaluating the pediatric discharge process from hospital admission through the transition to care within the community. <strong>Phase II :</strong> aims to assess pediatric discharge policies and facility readiness for change in a nationally representative sample of health facilities in Uganda. <strong>Phase III :</strong> aims to evaluate the effects of the Smart Discharges Health Worker Training Program on discharge care practices and procedures. <strong>Phase IV :</strong> aims to complete the facility-based linkage to care through the use of a community-based follow-up system. <br /> <br /><strong>Methods:</strong> Each of the four project phases utilizes different research methodologies. <strong>Phase I </strong> is a mixed methods prospective study utilizing patient journey mapping, discharge process mapping, and focus group discussions at 3 Ugandan Hospitals. <strong>Phase II </strong> is a cross-sectional, survey-based study conducted at 36 health facilities providing in-patient pediatric care in Uganda. <strong>Phase III and IV :</strong> (implemented together) is a quality improvement intervention at 16 health facilities in Uganda. <br /> <br /><strong>Discussion:</strong> Ultimately this work is focused on ensuring widespread adoption of Smart Discharges practices throughout Uganda by building capacity that ensures sustainability. Exploring and characterizing the existing pediatric discharge process, including human and health system factors that impact this process, will allow us to operationalize the Smart Discharges innovation into an effective health-systems approach to this neglected issue.<br /> <br /><strong>Ethics Declaration:</strong> Ethics approvals have been obtained from the Makerere University School of Public Health (MakSPH) Institutional Review Board (PI: 850; PII: 851; PIII/IV: 836), the Uganda National Council of Science and Technology (UNCST) in Uganda (PI: HS929ES; PII: HS928ES; PIII/IV: HS926ES) and the University of British Columbia in Canada (PI-IV: H20-02519). <br />
**数据集描述**：本数据集源自<https://bcchr.ca/smart-discharges>发布的Smart Discharges（智能出院）研究项目旗下的「Smart Discharges Transition to Scale」母研究，包含母研究方案及关联文档。相关出版物与数据集链接详见下文元数据章节。 **背景**：在乌干达，约5%因重症感染入院的儿童在出院后（多居家期间）死亡，其中多数本可避免——此类死亡主要源于出院流程与随访计划的不完善。医护人员与照护者往往未意识到这一脆弱照护期，也缺乏识别与处置此类危急情况的能力。本团队前期工作聚焦于开发并评估可在出院前预测儿童复发疾病风险的模型与技术，同时为高危儿童提供出院后额外支持。本项目旨在通过四阶段框架，探索智能出院项目的最优规模化路径，各阶段对应明确目标： 1. **第一阶段（Phase I）**：通过评估从医院入院到社区照护过渡的全流程儿科出院路径，明确出院质量欠佳的核心根源。 2. **第二阶段（Phase II）**：在乌干达具有全国代表性的医疗机构样本中，评估儿科出院政策与机构变革准备度。 3. **第三阶段（Phase III）**：评估智能出院医护人员培训项目对出院护理实践与流程的实际影响。 4. **第四阶段（Phase IV）**：依托社区随访系统，完成基于医疗机构的全流程照护衔接。 **研究方法**：本项目四个阶段采用差异化研究方法： 1. **第一阶段**：采用混合方法前瞻性研究设计，在乌干达3家医院开展患者旅程映射、出院流程映射与焦点小组讨论。 2. **第二阶段**：采用横断面调查研究设计，覆盖乌干达36家提供儿科住院服务的医疗机构。 3. **第三与第四阶段（同步实施）**：在乌干达16家医疗机构开展的质量改进干预项目。 **讨论**：本研究最终目标是通过构建可持续发展能力，推动智能出院实践在乌干达全境普及。通过系统梳理现有儿科出院流程并剖析影响流程的人力与卫生系统因素，可将智能出院创新转化为针对这一被忽视公共卫生问题的高效卫生系统解决方案。 **伦理声明**：本研究已获得以下机构的伦理审批：乌干达马克雷雷大学公共卫生学院（Makerere University School of Public Health, MakSPH）机构审查委员会（项目编号：PI: 850; PII: 851; PIII/IV: 836）、乌干达国家科学技术委员会（Uganda National Council of Science and Technology, UNCST，项目编号：PI: HS929ES; PII: HS928ES; PIII/IV: HS926ES），以及加拿大英属哥伦比亚大学（项目编号：PI-IV: H20-02519）。
