Expanding the Reach of a Fall Prevention Intervention for Older Adult Emergency Department Patients through Telehealth

通过远程医疗扩大急诊科老年患者跌倒预防干预的范围

• 批准号: 10331948
• 负责人: Elizabeth Goldberg
• 金额: $ 40.7万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10331948
• 关键词: Accident and Emergency department; Acute; Age; Agreement; Calendar; Caregivers; Caring; Centers of Research Excellence; Cessation of life; Clinical; Clinical Trials; Communities; Computer software; Consult; Consultations; Data; Data Analyses; Development; Devices; Elderly; Electronic Health Record; Emergency Department patient; Emergency Medicine; Emergency department visit; Evaluation; Expenditure; Fall prevention; Feasibility Studies; Feedback; Funding; Future; Gait; Geriatrics; Goals; Health; Health Care Visit; Home; Hospitalization; Hospitals; Impaired cognition; Injury; Interest Group; Intervention; Intervention Studies; Interview; Measures; Mentors; Methodology; Methods; Modeling; Motivation; Neurologist; Nurses; Participant; Patients; Peer Review; Persons; Pharmacists; Pharmacy facility; Physicians; Population; Prevention; Primary Care Physician; Procedures; Process Measure; Protocols documentation; Qualitative Research; Quality of life; Randomized; Recommendation; Recurrence; Research; Review Literature; Rhode Island; Risk Assessment; Risk Factors; Rural; Rural Community; Sampling; Scientist; Services; Site; Specialist; Stroke; Structure; Suggestion; Technology; Telephone; Testing; Time; Urban Community; Work; acceptability and feasibility; arm; base; behavior change; care seeking; career; digital health; efficacy evaluation; equilibration disorder; fall injury; fall risk; falls; improved; insight; pharmacy benefit; physical therapist; practice setting; prevent; preventive intervention; primary care setting; promoter; recruit; suburb; suburban communities; telehealth; uptake; virtual; working group

PROJECT SUMMARY The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) is a promising emergency department (ED) initiated intervention for reducing falls and healthcare visits in older adults; GAPcare reduced 6-month ED visits for falls by 66%, all-cause ED visits by 53%, and hospitalizations by 43%. Because GAPcare begins immediately after a fall occurs, motivation to change behavior is high. However, GAPcare requires in- person pharmacists and physical therapists (PTs), which limits scalability to large EDs, which account for only 43.8% of all ED visits. If we fail to scale this intervention, valuable prevention opportunities will be missed for the 2.8 Million older adults who seek care for falls in EDs each year. Our over-arching goal is to expand the reach of GAPcare by testing a video telehealth GAPcare (e-GAPcare) intervention in a community ED without existing pharmacy and PT services. The rationale for this research is that telehealth for specialist evaluations have already been successfully implemented in EDs, suggesting that GAPcare could be adapted for patients with falls who would benefit from pharmacy and PT consultation, but cannot receive them due to staffing limitations in rural or smaller community EDs. Our long-term goal is to prevent falls in older adults and healthcare visits. The overall objective of this application is to develop and test a telehealth intervention for falls based on our successful GAPcare model. Our central hypothesis is that e-GAPcare will help ED clinicians identify fall risk factors, such as gait, balance, and cognitive impairment and could ameliorate these risk factors through action plans co-created with patients preventing the next fall. GAPcare’s specific aims are to: (1) conduct semi-structured interviews (n=18-24) with content experts in telehealth stratified by practice setting (metro/suburban/rural) to gain insights about the practical considerations; (2) refine the GAPcare intervention and study protocol based on feedback from ED staff, patient and caregivers; and (3) conduct a single arm feasibility study with older adult ED patients (n=40) with a recent fall to determine if they can complete the fall risk assessment and intervention to assess the feasibility and acceptability of e- GAPcare. Dr. Goldberg will obtain initial estimates of efficacy for a larger, multi-center GAPcare III trial. Using phone calls and the electronic health record we will measure subsequent falls, and healthcare visits at 6 months, to inform initial efficacy for our subsequent larger, multi-center GAPcare III trial. Dr. Goldberg’s e-GAPcare overarching aims are to develop and test an ED-based telehealth intervention that reduces recurrent falls and healthcare visits and to launch her physician-scientist career at the intersection of emergency medicine and geriatrics. To achieve this goal, Dr. Goldberg will work with her mentors Drs. Resnik and Ranney to improve her expertise in qualitative research, digital health, longitudinal data analysis, and clinical trial methods. Upon successful completion of the proposed research, we will produce a fully piloted, community- informed telehealth intervention tailored to the unique health needs of older adults with falls.

项目摘要 老年急性和急性后秋季预防干预（GAPCARE）是承诺紧急 部门（ED）开始了减少老年人跌倒和医疗访问的干预措施； Gapcare减少了 6个月的ED访问跌倒了66％，全因ED访问量增加了53％，住院率为43％。因为Gapcare 秋天发生后立即开始，改变行为的动机很高。但是，Gapcare需要 人员药剂师和物理治疗师（PTS），将可扩展性限制为大型ED，仅考虑 所有ED访问的43.8％。如果我们无法扩展这种干预措施，则将错过宝贵的预防机会 每年有280万寻求照顾的老年人跌倒。我们的整理目标是扩大覆盖范围 通过在没有现有的社区中测试社区的视频远程医疗Gapcare（E-Gapcare）干预，通过测试GAPCARE 药房和PT服务。这项研究的理由是专家评估的远程医疗 已经在ED中成功实施了 谁会从药房和PT咨询中受益，但由于人员配备限制而无法获得 农村或小型社区Eds。我们的长期目标是防止老年人和医疗访问的跌倒。这 该应用的总体目的是根据我们的 成功的Gapcare模型。我们的核心假设是，电子间谍将帮助ED临床医生确定跌倒的风险 因素，例如敏捷，平衡和认知障碍，可以通过行动来改善这些危险因素 与阻止下秋天的患者共同创建的计划。 Gapcare的具体目的是：（1）与内容专家进行半结构化访谈（n = 18-24） 通过实践环境（Metro/郊区/农村）对远程医疗进行分层，以获得有关实际考虑因素的见解； （2）根据ED员工，患者和护理人员的反馈来完善GapCare干预和研究方案； （3）对老年人ED患者（n = 40）进行一次单臂可行性研究，最近下降以确定 如果他们可以完成秋季风险评估和干预措施，以评估电子的可行性和可接受性 Gapcare。 Goldberg博士将获得较大的多中心Gapcare III试验的效率的初步估计。使用 电话和电子健康记录我们将衡量随后的跌倒，以及6个月的医疗访问 为了为我们随后的较大的多中心Gapcare III试验提供初始效率。 戈德伯格博士的电子空白总体目的是开发和测试基于ED的远程医疗干预措施 减少经常出现的瀑布和医疗访问，并在交叉路口发起她的身体科学家职业 急诊医学和老年医学。为了实现这一目标，戈德伯格博士将与她的导师Drs合作。 Resnik 兰尼（Ranney）提高了她在定性研究，数字健康，纵向数据分析和临床方面的专业知识 试验方法。成功完成拟议的研究后，我们将生产一个完全试验的社区 - 根据跌倒的老年人独特的健康需求量身定制的知情远程医疗干预措施。