Emergency General Surgery Delirium Recovery Model: A Collaborative Care Intervention

急诊普通外科谵妄恢复模型：协作护理干预

基本信息

批准号：
10416631
负责人：
MALAZ BOUSTANI
金额：
$ 207.53万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10416631
关键词：
Activities of Daily Living Acute Address Adhesions Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American Caring Chronic Chronic Care Chronic Disease Cognition Cognitive Colectomy Complex Conscious Country Cytolysis Delirium Dementia Dependence Elderly Emergency Situation Ensure Excision Generalized Anxiety Disorder Goals Health Health Services Hospitalization Hospitals Human Impaired cognition Indiana Intervention Intra-abdominal Knowledge Laparotomy Lead Life Expectancy Measures Medical Mental Depression Mission Modeling Morbidity - disease rate Neuropsychology Operative Surgical Procedures Outcome Study Patients Peptic Ulcer Physical Performance Physicians Positioning Attribute Postoperative Period Primary Health Care Psyche structure Public Health Quality of Care Quality of life Questionnaires Randomized Randomized Controlled Clinical Trials Randomized Controlled Trials Recovery Recovery of Function Research Research Personnel Risk Small Intestines Survivors Syndrome United States National Institutes of Health Universities Wisconsin Work anxiety symptoms base biopsychosocial cognitive recovery collaborative care disability efficacy evaluation evidence base experience feasibility testing frailty functional decline functional independence functional loss health care service utilization high risk human old age (65+)improved indexing innovation medical schools medical specialties meetings mood symptom neuropsychiatry operation patient population personalized care postoperative delirium prevent programs psychologic recruit repaired telehealth treatment as usual

项目摘要

Project Summary Delirium is a complex neuropsychiatric syndrome characterized by acute and fluctuating changes in cognition and consciousness. Delirium survivors suffer from a cluster of cognitive, physical, and psychological disabilities. These disabilities lead to high healthcare utilization, lower quality of life, and loss of functional independence. Worse, a single episode of delirium increases the risk of Alzheimer disease and related dementias. Based on work from our group and the work of others, over 25% of patients who undergo emergency intra-abdominal surgery suffer from at least one episode of delirium during the index hospitalization, putting them at high risk for cognitive decline. There is a fundamental gap in knowledge regarding the best way to prevent cognitive, psychological and functional decline in patients who undergo emergency general surgery and subsequently develop delirium. The long-term goal of this line of research is to improve the health and quality of care for older emergency general surgery survivors. The objective of this application is to apply the concepts of collaborative care to a high-risk patient population. Indiana University School of Medicine and University of Wisconsin School of Medicine and Public Health researchers have over 20 years of experience developing innovative and effective collaborative care models that integrate with primary care and specialty physicians to address the complex biopsychosocial needs of patients with chronic disease states, such as dementia and depression. Our team has developed a specific collaborative care model called the Emergency General Surgery Delirium Recovery Program. This proposal aims to conduct a randomized controlled trial to evaluate the efficacy of 12-months of collaborative care in improving the cognitive, functional and psychological recovery of emergency intra-abdominal surgery patients who suffer at least one episode of delirium in the post-operative period and are at least 65 years old. The trial has the following specific aims: 1) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the cognitive recovery of older Emergency General Surgery delirium survivors; and 2) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the physical recovery of older Emergency General Surgery delirium survivors; and 3) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the psychological recovery of older Emergency General Surgery delirium survivors. The research proposed in this application is innovative because it represents a new and substantive departure from the status quo. Previous collaborative care models focused on chronic care management and they lack rapid adaptability. We have also adapted the intervention to be completed solely via telehealth. This contribution will be significant as broad application of the Emergency General Surgery Delirium Recovery Program at hospitals across the country could result in better health and improved quality of care for a particularly vulnerable patient population.

项目摘要 ir妄是一种复杂的神经精神综合征，其特征是认知的急性和波动变化和意识。 ir妄幸存者遭受一群认知，身体和心理的困扰残疾。这些残疾导致高度医疗保健利用，较低的生活质量和功能丧失独立。更糟糕的是，一次ir妄的一集增加了阿尔茨海默氏病和相关的风险痴呆症。根据我们小组的工作和其他人的工作，超过25％的患者接受在该指数期间，紧急腹腔内手术至少遭受del妄的一集住院，使他们有认知能力下降的高风险。知识存在根本差距关于预防经历认知，心理和功能下降的最佳方法紧急一般手术，随后发展ir妄。这一研究的长期目标是为了改善较老的急诊一般手术幸存者的健康和护理质量。这个目的应用是将协作护理的概念应用于高危患者人群。印第安纳大学医学院和威斯康星大学医学和公共卫生研究人员已经结束 20年的经验开发了与之融合的创新和有效的协作护理模型初级保健和专科医生，以满足慢性患者的复杂生物心理需求疾病状态，例如痴呆和抑郁症。我们的团队开发了一个特定的协作护理模型称为紧急通用手术ir妄恢复计划。该建议旨在进行随机对照试验，以评估12个月协作护理的功效紧急腹腔内手术患者的认知，功能和心理恢复患者在术后时期，至少有一个del妄的一集，至少65岁。试验有以下特定目的：1）评估紧急通用手术ir妄模型的能力改善较老的紧急通用手术ir妄幸存者的认知恢复； 2）评估紧急通用手术ir妄恢复模型的能力改善老年人的身体恢复紧急一般手术ir妄幸存者； 3）评估紧急通用手术的能力 del妄恢复模型，以改善较早的紧急一般手术del妄的心理恢复幸存者。本应用程序中提出的研究具有创新性，因为它代表了一种新的实质性偏离现状。以前的协作护理模型侧重于慢性护理管理和他们缺乏快速的适应性。我们还改编了干预措施，仅通过远程医疗完成。这贡献将是重要的，因为紧急通用手术ir妄恢复的广泛应用全国各地医院的计划可能会改善健康和改善的护理质量特别脆弱的患者人数。