Implementing Advance Care Planning as a Healthy Aging Activity in Rural Primary Care

在农村初级保健中实施预先护理计划作为健康老龄化活动

• 批准号: 10557515
• 负责人: HEATHER Vachelle NELSON-BRANTLEY
• 金额: $ 17.66万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-11 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557515
• 关键词: Address; Administrator; Adoption; Adult; Advance Care Planning; Advance Directives; Age; Caring; Centers of Research Excellence; Chronic; Chronic Disease; Clinic; Clinics and Hospitals; Code; Cognitive; Consensus; Consolidated Framework for Implementation Research; Data; Disparity; Elderly; Electronic Health Record; Elements; Equipment and supply inventories; Equity; Evidence based practice; Face; Family; Future; Gerontology; Goals; Healthcare; High Prevalence; Hybrids; Institutional Review Boards; Intervention; Kansas; Knowledge; Lead; Life; Medicare; Mentors; Modification; Needs Assessment; Outcome; Outcome Study; Palliative Care; Patients; Pilot Projects; Population; Prevention Research; Primary Care; Procedures; Process; Protocols documentation; Provider; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resource-limited setting; Resources; Rural; Rural Population; Rural health equity; Secure; Services; Site; Testing; Time; Training; Training Support; Training and Education; Translating; Work; access disparities; comparative; cost; demographics; economic evaluation; effective intervention; effectiveness outcome; end of life care; evidence base; health care quality; health care service; health communication; healthy aging; human old age (65+); hybrid type 2 trial; implementation facilitation; implementation outcomes; implementation science; implementation strategy; improved; medically underserved; novel; poor health outcome; post implementation; practice-based research network; primary care clinic; primary care provider; rural America; rural area; satisfaction; underserved rural area; uptake; urban area

PROJECT SUMMARY/ABSTRACT: PROJECT 2 (NELSON-BRANTELY) The U.S. population age 65 and over is projected to reach 94.7 million in 2060; presently, more than one-fifth of the nation’s elderly reside in rural America. Advance care planning (ACP) is a process of care that supports adults in sharing their values, life goals, and choices regarding future health care. ACP increases alignment of health care services with patients’ values, improves patient and family satisfaction, increases use of palliative care, and reduces costs. Despite global consensus that ACP should start early for older adults, ACP usually happens too late or not at all. Effective interventions to increase ACP exist, yet an extensive gap remains in translating the intervention into everyday practice. This is particularly true in rural primary care clinics. This project pilots the use of implementation facilitation (IF) for improving the uptake of ACP in rural primary care clinics. IF involves an integrated set of implementation strategies to promote adoption of an evidence- based practice—in this study, ACP. The IF strategies in the proposed study include Respecting Choices First Steps® ACP training, an ACP toolkit, and tele-mentoring for ongoing implementation and training support. The PrISM Core will assist with refining study procedures; the CEO Core with engaging clinic sites; and the HSR Core with securing final IRB approval for the study protocol. Develop a tailored ACP plan for implementing ACP into rural primary care clinics (Aim 1). We will use the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to ACP, conduct a needs assessment, and develop an ACP plan adapted to the local context of each clinic. Characterize the reach, estimated effect, adoption, and implementation using IF for implementing ACP (Aim 2). This study pilots a Hybrid Type 229 protocol, estimating both effectiveness and implementation outcomes. We will estimate effect size and associated variability, describe the reach, adoption, and implementation of ACP using IF, and descriptively compare IF to implementation as usual (IAU). Describe the costs and revenue generated from using IF for implementing ACP (Aim 3). Feasibility assessment of elements necessary for a definitive trial economic evaluation will be conducted. Costs will be captured through a clinic service receipt inventory and revenue through ACP billing codes. The project aligns with the goals of the proposed COBRE to improve health equity for rural populations and will advance the field of implementation science vertically by providing new knowledge of implementation strategies that work in rural primary care clinics. The outcomes of this study will provide an evidence base to support an R01 application testing the IF strategy on a larger scale. Ultimately, this research is expected to have a positive impact by expanding ACP to medically underserved rural areas and improving early ACP for older adults before they are no longer able to make their wishes known.

项目摘要/摘要：项目2（Nelson-Brantely） 美国65岁及以上的美国人口预计将在2060年达到9470万；目前，超过五分之一 该国的最古老的居住在美国农村。预先护理计划（ACP）是一个支持的护理过程 成年人分享有关未来医疗保健的价值观，人寿目标和选择。 ACP增加对齐 具有患者价值观的医疗保健服务，提高患者和家庭满意度，增加姑息治疗的使用 护理并降低成本。尽管全球共识，即ACP应该早于老年人开始，但ACP通常 发生得太晚或根本不会发生。存在有效增加ACP的干预措施，但仍然存在很大的差距 将干预措施转化为每天的练习。在农村初级保健诊所尤其如此。 该项目钢琴使用实施设施（IF）改善ACP在农村小学中的吸收 护理诊所。如果涉及一组综合的实施策略，以促进通过证据的采用 - 基于实践 - 在这项研究中，ACP。拟议研究中的IF策略首先包括尊重选择 Step®ACP培训，ACP工具包以及远程实施和培训支持。这 Prism Core将有助于提炼研究程序； CEO CORE，具有参与诊所地点；和HSR 通过确保最终IRB批准研究方案的核心。 制定量身定制的ACP计划，以将ACP实施到农村初级保健诊所（AIM 1）。 我们将使用合并框架进行实施研究（CFIR）来识别障碍和 主持ACP的促进者，进行需求评估，并制定适合当地背景的ACP计划 每个诊所。 使用IF来表征覆盖范围，估计效果，采用和实施ACP （目标2）。这项研究猪是一种混合型229方案，估计有效性和实施 结果。我们将估计效果大小和相关的可变性，描述覆盖范围，采用和 使用IF的ACP实施，并描述地比较是否像往常一样实现（IAU）。 描述用于实施ACP的IF产生的成本和收入（AIM 3）。 将对确定的试验经济评估所需的要素进行可行性评估。 费用将通过临床服务收据清单和通过ACP计费代码来捕获。 该项目符合拟议的毛病的目标，以改善人口的健康公平，并将 通过提供新的实施知识，垂直推进实施科学领域 在农村初级保健诊所工作的策略。这项研究的结果将为 支持R01应用程序测试IF策略。最终，这项研究有望 通过将ACP扩展到医疗服务不足的农村地区并改善早期ACP，从而产生积极的影响 在老年人不再能够使自己的愿望中的老年人之前。