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（纳尔逊-布兰特利） 预计到 2060 年，美国 65 岁及以上人口将达到 9470 万，超过五分之一； 的老年人居住在美国农村地区。 预先护理计划 (ACP) 是一个支持护理的过程。 成年人分享他们的价值观、生活目标和关于未来医疗保健的选择可以增强人们的一致性。 医疗保健服务符合患者的价值观，提高患者和家属的满意度，增加姑息治疗的使用 尽管全球一致认为老年人应尽早开始 ACP，但 ACP 通常 存在提高 ACP 的有效干预措施，但仍存在巨大差距。 将干预措施转化为日常实践，这在农村初级保健诊所尤其如此。 该项目试点使用实施促进 (IF) 来提高农村小学对 ACP 的采用 IF 涉及一套综合的实施策略，以促进证据的采用。 基于实践——在本研究中，ACP 拟议研究中的 IF 策略包括尊重选择第一。 Steps® ACP 培训、ACP 工具包以及持续实施和培训支持的远程指导。 PrISM 核心将协助完善研究程序；CEO 核心将参与临床地点和 HSR； 核心是确保 IRB 对研究方案的最终批准。 制定量身定制的 ACP 计划，在农村初级保健诊所实施 ACP（目标 1）。 我们将使用实施研究综合框架（CFIR）来识别障碍和 ACP 的推动者，进行需求评估，并制定适合当地情况的 ACP 计划 每个诊所。 使用 IF 来实施 ACP 来描述范围、估计效果、采用和实施 （目标 2）本研究试行了混合型 229 协议，评估有效性和实施情况。 我们将估计效果大小和相关的变异性，描述影响范围、采用情况和结果。 使用 IF 实现 ACP，并描述性地将 IF 与通常的实现 (IAU) 进行比较。 描述使用 IF 实施 ACP（目标 3）所产生的成本和收入。 将进行最终试验经济评估所需要素的可行性评估。 成本将通过诊所服务收据库存记录，收入通过 ACP 账单代码记录。 该项目符合拟议的 COBRE 改善农村人口健康公平的目标，并将 通过提供新的实施知识，实施科学领域垂直推进 这项研究的结果将为农村初级保健诊所的有效策略提供证据基础。 最终，这项研究预计将支持 R01 应用程序在更大规模上测试 IF 策略。 通过将 ACP 扩展到医疗服务不足的农村地区并改善早期 ACP 来产生积极影响 在老年人无法再表达自己的愿望之前。