The ENRICH Study: Engaging Community and Municipal Services to Promote High Quality Aging in Place After Hip Fracture

ENRICH 研究：社区和市政服务的参与促进髋部骨折后高质量的就地养老

基本信息

批准号：
10493287
负责人：
Jason Raymond Falvey
金额：
$ 23.5万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2026-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10493287
关键词：
Address Aging Award Baltimore Caring Censuses Characteristics Communities Conduct Clinical Trials Data Data Analyses Development Disabled Persons Disadvantaged Durable Medical Equipment Elderly Environment Equipment Funding Goals Health Status Health care facility Hip Fractures Hip region structure Home Home Care Services Home Nursing Care Hospitalization Housing Individual Infrastructure Intervention Interview Journals Link Maryland Medicare claim Mentors Mentorship Methods Mission Modeling Municipalities National Institute on Aging Neighborhoods Older Population Outcome Outcomes Research Patient-Focused Outcomes Patients Physical activity Population Population Heterogeneity Positioning Attribute Process Protocols documentation Public Health Recommendation Recovery Rehabilitation therapy Research Research Training Resources Risk Assessment Scientist Screening procedure Self-Help Devices Services Site Survivors Testing Training Transportation Universities Work aging in place aging population base built environment career career development clinical care disability exercise training experience feasibility trial health care disparity improved longitudinal analysis medical schools neighborhood disadvantage novel patient engagement patient oriented peer peer coaching physical therapist pilot test programs skills socioeconomic disadvantage successful intervention treatment as usual

项目摘要

PROJECT SUMMARY: The quantity and quality of aging in place after a hip fracture is poor, and these outcomes have not improved substantially over the last 20 years. The built environment in an older adult’s neighborhood has a strong influence on the quality of aging in place 4-6—yet has not been addressed in usual hip fracture care. This is especially concerning for older adults who live in socioeconomically disadvantaged neighborhoods, which have fewer resources to support high-quality built environment infrastructure. 5 Crumbling sidewalks and curbs in disadvantaged neighborhoods are associated with a 400% increase in mobility disability for older adults. 7 Older adults living in disadvantaged neighborhoods are also more likely to perceive their neighborhoods to be unsafe, and thus less likely to participate in physical activity outside. In this Beeson K76 award, Dr. Falvey proposes a novel model of ENgaging community and municipal seRvICes to promote high-quality aging in place after Hip fracture (ENRICH). ENRICH uniquely combines successful mobility interventions from prior work on hip fracture recovery, proactively identifying neighborhood- level barriers to recovery during the transition home after hip fracture, helping obtain needed services and equipment to bridge gaps related to the built environment, and provide targeted additional rehabilitation that focuses on community level mobility in a real-world environment after completion of usual care. The goal of ENRICH is promoting greater mobility in the community and allowing older adults to participate in community activities to improve the quality of aging in place. To tailor ENRICH for Baltimore, this project will 1) gather information on which factors (e.g. housing) most strongly impact the number of healthy days spent at home after hip fracture, using Medicare claims data linked with US Census Bureau data; 2 use this data to guide interviews with patient and clinician stakeholders to elucidate meaningful adaptations of ENRICH; and 3) pilot test the adapted ENRICH intervention with 24 older hip fracture patients living in disadvantaged neighborhoods. Completing these aims will help launch Dr. Falvey’s career as an independent clinician-scientist and leader in the fields of rehabilitation and aging. He proposes to gain complementary skills in longitudinal and mixed methods data analysis, patient-centered outcomes research, healthcare disparities, and conduct of clinical trials. His mentorship team, led by Dr. Jay Magaziner, is well-positioned to help him complete the study successfully and support his career development.

项目概要：髋部骨折后原位老化的数量和质量都很差，并且这些结果没有改善过去 20 年来，老年人社区的建筑环境显着增强。对就地老化质量的影响 4-6——但在通常的髋部骨折护理中尚未得到解决。特别是对于生活在社会经济弱势社区的老年人来说，支持高质量建筑环境基础设施的资源较少 5 人行道和路缘石摇摇欲坠。弱势社区与老年人行动障碍增加 400% 7 老年人有关。生活在贫困社区的成年人也更有可能认为他们的社区是不安全，因此不太可能参加户外体育活动。在 Beeson K76 奖中，Falvey 博士提出了一种吸引社区和市政的新颖模型促进髋部骨折后高质量就地养老的服务 (ENRICH) 独特地结合在一起。从先前的髋部骨折恢复工作中成功进行活动干预，主动识别邻里髋部骨折后回家过渡期间的恢复水平，帮助获得所需的服务和设备来弥补与建筑环境相关的差距，并提供有针对性的额外修复，重点关注完成常规护理后现实世界环境中的社区级流动性。 ENRICH 正在促进社区更大的流动性，并允许老年人参与社区提高就地养老质量活动。为了为巴尔的摩量身定制 ENRICH，该项目将 1) 收集有关哪些因素（例如住房）的信息根据医疗保险索赔数据，对髋部骨折后在家中度过的健康天数影响最大与美国人口普查局数据关联；2 使用该数据指导对患者和临床医生利益相关者的访谈阐明 ENRICH 的有意义的调整；以及 3) 对调整后的 ENRICH 干预措施进行试点测试 24 居住在贫困社区的老年髋部骨折患者。完成这些目标将有助于开启 Falvey 博士作为独立临床医生科学家的职业生涯，他是康复和老龄化领域的领导者，他建议获得纵向和老年领域的互补技能。混合方法数据分析、以患者为中心的结果研究、医疗保健差异以及实施他的导师团队由 Jay Magaziner 博士领导，能够很好地帮助他完成这项研究。成功并支持他的职业发展。