title: Effects of a patient/family-centered practice change on the quality and cost of intensive care: research protocol.
abstract: OBJECTIVE
  This paper is a description of a protocol for studying the impact of a patient/family-centered, evidence-based practice change on the quality, cost and use of services for critically ill patients at the end of life.
  
  
  BACKGROUND
  International attention currently is focused on the quality and cost/use of intensive care services. Empirical literature and expert opinion suggest that early, enhanced communication among the clinical team and the patient and family results in higher quality and less costly care at the end of life.
  
  
  METHODS
  Our Medical Intensive Care Unit practice change involves three components: teaching sessions for all Registered Nurses and physicians assigned to the unit; patient/family meetings held in 72 hours of the patient's admission to the unit; and formal documentation to support communication among clinicians. Ethical approval was obtained in April 2009. A two-group post-test design is used, with one group comprising patients hospitalized before the practice change and their families, and the second group of patients/families after the practice change. Data comprise medical record information and families' responses to surveys. Final analytic models will result from multivariable regression techniques.
  
  
  CONCLUSIONS
  The study represents translational research in that interventions are brought to the bedside to reach the people for whom the interventions were designed. The practice change is likely to endure after the study because our research team is composed of both clinicians and scientists. Also, direct care clinicians endorse and are responsible for the practice change.
authors.affiliation: University of Massachusetts Boston, Chelmsford, Massachusetts, USA. ler627@gmail.com
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Radwin
authors.forename: Lillian
authors.initials: L
authors.lastname: Ananian
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Cabral
authors.forename: Adele
authors.initials: A
authors.lastname: Keeley
authors.forename: Paul F
authors.initials: PF
authors.lastname: Currier
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001294:Attitude to Health; D015400:Clinical Nursing Research; D002985:Clinical Protocols; D003142:Communication; D003422:Critical Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D004496:Education, Continuing / Q000458:organization & administration; D019317:Evidence-Based Medicine; D005190:Family; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008499:Medical Records; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D011368:Professional-Family Relations; D011785:Quality Assurance, Health Care; D012107:Research Design; D013727:Terminal Care / Q000191:economics / Q000458:organization & administration / Q000592:standards; D055815:Young Adult