GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare II：老年急性病

基本信息

批准号：
10161679
负责人：
Elizabeth Goldberg
金额：
$ 23.83万
依托单位：
RHODE ISLAND HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10161679
关键词：
Accelerometer Accident and Emergency department Accreditation Acute Address Age Aging Apple watch Award Caregivers Caring Clinical Trials Communication Data Data Analyses Death Rate Devices Elderly Emergency Care Emergency Department patient Emergency Medicine Emergency department visit Epidemiologist Epidemiology Evaluation Failure Fall prevention Future Gait Goals Health Care Costs Health Policy Health Services Health Services Research Healthy People 2020 Home Impaired cognition Injury Intervention Intervention Studies Investigation Leadership Life Measures Medication Management Mentors Mentorship Methodology Methods Modeling Modification Monitor Morbidity - disease rate Outcome Outpatients Participant Patient Self-Report Patients Pattern Periodicity Persons Pharmaceutical Preparations Pharmacists Pharmacy facility Physicians Physiological Pilot Projects Policies Population Preparation Prevention Protocols Principal Investigator Process Measure Protocols documentation Proxy Public Health Qualitative Methods Qualitative Research Randomized Controlled Trials Recommendation Recurrence Rehabilitation therapy Research Research Personnel Resources Risk Factors Safety Sampling Scientist Series Specialist Standardization Technology Telephone Testing Time Training Work acceptability and feasibility acute care base care coordination care providers career collaborative approach digital health disability experience fall risk falls field study fitness follow-up health care service utilization high risk modifiable risk mortality multidisciplinary physical therapist prevent preventive intervention programs recruit response retention rate sensor treatment as usual uptake usability wearable device

项目摘要

PROJECT SUMMARY Falls by older adults are often predictable and preventable, yet there is a notable lack of research evaluating interventions to reduce the occurrence of recurrent falls in older adult Emergency Department (ED) patients. Dr. Goldberg’s Beeson K76 project GAPcare II, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, addresses this lack of research by further refining and examining the intervention she created in her GEMSSTAR R03 project. In this intervention, patients, caregivers, physical therapists (PTs), pharmacy specialists, and clinicians provide a patient-centric, collaborative approach to fall prevention that bridges the ED visit with outpatient resources. PTs evaluate geriatric patients in the ED immediately after their fall, perform a focused assessment of future fall risk and determine the safety of discharge home. Pharmacists in the ED perform a medication therapy management session aimed at reducing/tapering fall risk increasing medication. ED clinicians, patients and caregivers in turn incorporate the advice offered by these professionals before the patient leaves the ED. In her Beeson K76 GAPcare II project, Dr. Goldberg will build on the lessons learned from the GEMSSTAR R03 work. GAPcare II’s specific aims are to: (1) conduct field testing with geriatric patients with and without cognitive impairment and their caregivers to assess the feasibility, acceptability, and usability of the Apple Watch to objectively measure fall-related outcomes; (2) refine the GAPcare intervention and study protocol based on lessons learned and findings from the GEMSSTAR R03 GAPcare I pilot study and conduct a small open trial of the GAPcare II intervention; and (3) conduct a pilot randomized, controlled trial (RCT) of the GAPcare II (n=200) intervention to obtain initial estimates of efficacy of GAPcare II to decrease recurrent falls at 12 months relative to usual care. This investigation will provide Dr. Goldberg with critical pilot data and expertise to submit a R01 proposal to NIA for a full-scale, multi-center, comprehensive RCT. Dr. Goldberg’s Beeson K76 award overarching aims are to develop and test an ED-based and post-discharge protocol that reduces recurrent falls in older adults and to launch her physician-scientist career as an emerging leader in geriatric emergency medicine. To achieve this goal, Dr. Goldberg will obtain additional training in qualitative research, digital health, longitudinal data analysis, clinical trial methods, and leadership. This expertise will be achieved through advanced coursework, leadership training, and intensive interactions with her mentorship team. Her primary mentors, Dr. Roland Merchant, emergency medicine physician and epidemiologist, and Dr. Vincent Mor, health services researcher and health policy expert, will provide training in epidemiology, health services research, and leading policy initiatives. Her mentorship team also includes experts in qualitative research, digital health, rehabilitation measures, longitudinal data analysis, clinical trial methods, fall prevention and geriatric medication management.

项目摘要老年人的跌倒通常是可以预测的，并且可以预防，但显然缺乏研究评估减少老年人急诊科（ED）患者的复发性发生的干预措施。 Goldberg博士的Beeson K76 Project Gapcare II，老年急性和急性护理协调计划对于急诊科的秋季预防，通过进一步的完善和检查她在Gemsstar R03项目中创建的干预措施。在这种干预措施中，患者，护理人员，物理治疗师（PTS），药品专家和临床医生提供以患者为中心的与门诊资源一起桥接ED参观的协作方法。 PTS评估急诊室跌倒后立即在急诊室中的老年患者，对未来跌倒风险的重点评估和确定出院的安全。 ED中的药剂师进行药物治疗管理旨在降低/缩减跌落风险增加药物的会议。 ED临床医生，患者和护理人员转弯将这些专业人员提供的建议纳入了患者离开ED之前。在她的Beeson K76 Gapcare II项目中，Goldberg博士将建立在Gemsstar中学的教训的基础上 R03工作。 Gapcare II的具体目的是：（1）与患有和没有的老年患者进行现场测试认知障碍及其评估苹果的可行性，可接受性和可用性观看客观测量与跌倒有关的结果；（2）完善Gapcare干预和研究方案基于从Gemsstar R03 Gapcare I先生研究中学到的经验教训和发现，并进行小型 Gapcare II干预的开放试验；（3）进行一项飞行员随机对照试验（RCT） Gapcare II（n = 200）干预措施以获得Gapcare II效率的初步估计，以减少复发性下降相对于通常的护理12个月。这项调查将为戈德伯格博士提供关键的飞行员数据和向NIA提交R01提案的专业知识，以提供全面的，多中心的全面RCT。 Goldberg博士的Beeson K76奖的总体目的是开发和测试基于ED的和分期的收费减少老年人反复出现的协议，并从事她的身体科学家职业老年急诊医学领导者。为了实现这一目标，戈德堡博士将获得其他培训定性研究，数字健康，纵向数据分析，临床试验方法和领导力。这通过高级课程，领导培训和与之进行密集互动来实现专业知识她的心态团队。她的主要心态，Roland Merchant博士，急诊医学医师和流行病学家，健康服务研究员和健康政策专家Vincent Mor博士将提供培训在流行病学，卫生服务研究和领导政策计划中。她的指导团队还包括定性研究，数字健康，康复措施，纵向数据分析，临床试验专家方法，预防秋季和老年药物管理。