GAPcare: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare：老年急性病

基本信息

批准号：
9364690
负责人：
Elizabeth Goldberg
金额：
$ 12.08万
依托单位：
RHODE ISLAND HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-15 至 2019-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9364690
关键词：
Accident and Emergency department Acute Address Administrator Admission activity Adult Adverse drug event Calendar Caregivers Caring Collaborations Communities Continuity of Patient Care Data Discharge Plannings Elderly Eligibility Determination Emergency Care Emergency Department Physician Emergency Department evaluation Emergency Department patient Emergency Department-based Intervention Emergency department visit Enrollment Evaluation Exercise Failure Fall prevention Feedback Goals Health Care Costs Health Care Visit Home environment Hospitals Injury Intervention Investigation K-Series Research Career Programs Length of Stay Location Mission Modeling Morbidity - disease rate National Institute on Aging Occupational Therapy Older Population Outpatients Participant Patients Pharmacists Physical therapy Physicians Preventive Intervention Public Health Quality of life Randomized Recruitment Activity Recurrence Research Risk Factors Sample Size Specialist Spottings Standardization Suggestion Testing Time Training United States National Institutes of Health arm base career development collaborative care design falls follow-up health care service utilization high risk human old age (65+)improved improved functioning improved outcome innovation mortality multidisciplinary physical therapist prevent programs satisfaction tool treatment as usual treatment planning

项目摘要

PROJECT SUMMARY Falls are the leading injury-related cause of Emergency Department (ED) visits in older adults and are both preventable and predictable, but the typical ED evaluation focuses on an injury assessment only. GAPcare, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, is an early stage investigation for preventing recurrent falls in older adults that present to the ED. Participants in this study will be adults ( 65 years old) who had a fall and present to the ED for care. We will randomly assign participants to an intervention or usual care arm. In the intervention arm physical therapists (PTs), pharmacists, and the ED physician collaborate to identify reasons the patient fell and address any identified risk factors. Seniors will return home with a standardized checklist containing details of their assessment and an exercise plan. These participants are referred to the same PT group for outpatient physical or occupational therapy, to provide continuity of care. Participants in the usual care arm receive care as provided by the ED physician only. Our long-term goal is to prevent the early morbidity and mortality of older adults who present to the ED after a fall. The overall objective of this investigation is to gather preliminary data on the feasibility, initial efficacy, and to solicit feedback on the GAPcare intervention to further refine our approach for the subsequent study. The central hypothesis is that GAPcare will lead to fewer falls by eliminating risk factors and giving patients tools for improving function. The rationale is that the ED visit is a teachable moment, in which patients and caregivers are engaged and collaboration of specialists is possible. Older adults have many barriers to accessing timely and comprehensive fall evaluations after discharge. We will pursue the following specific aims to test and further refine the GAPcare intervention: (1) Examine the feasibility of recruitment and retention of eligible patients into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention in reducing subsequent falls and healthcare utilization at 6 months. This will inform the effect size and sample size calculations for the subsequent study, and (3) solicit feedback from physicians and patients on their satisfaction with the GAPcare intervention. This investigation is expected to have two major contributions: 1. We will gather information on the feasibility, initial efficacy, and solicit feedback on the GAPcare intervention, which will help refine our approach for the subsequent study and 2. Dr. Goldberg will receive the training and preliminary data to submit a larger study as a K award to the National Institute on Aging. The public health significance of this intervention is immense as falls are the leading cause of fatal and non-fatal injury in older adults and no model of collaborative care exists to direct ED administrators and other stakeholders to reduce the occurrence of subsequent falls. This proposal is highly innovative because unlike other community-based programs it targets the most high-risk seniors in the ED during the period immediately after a fall when patients are most vulnerable for repeat falls and highly engaged in their care.

项目概要跌倒是老年人急诊科 (ED) 就诊的首要伤害相关原因，并且都是可预防和可预测，但典型的 ED 评估仅侧重于伤害评估。 GAPcare，急诊科预防跌倒的老年急性和急性后护理协调计划，是一项早期调查，旨在预防向急诊科就诊的老年人反复跌倒。参加者这项研究的对象是跌倒并到急诊室接受护理的成年人（65 岁）。我们会随机将参与者分配到干预组或常规护理组。在干预组物理治疗师 (PT) 中，药剂师和急诊室医生合作查明患者跌倒的原因并解决任何已发现的问题风险因素。老年人将带着一份标准化清单回家，其中包含他们的评估详细信息和锻炼计划。这些参与者被转介到同一 PT 小组进行门诊身体或职业治疗治疗，以提供连续性护理。常规护理组的参与者接受急诊室提供的护理仅限医生。我们的长期目标是预防老年人的早期发病和死亡摔倒后去急诊室。这项调查的总体目标是收集有关可行性的初步数据，初步疗效，并征求有关 GAPcare 干预措施的反馈，以进一步完善我们的方法后续研究。核心假设是，GAPcare 将通过消除风险因素和减少跌倒次数为患者提供改善功能的工具。理由是急诊科就诊是一个有教育意义的时刻，其中患者和护理人员都参与其中，专家之间的合作也是可能的。老年人有很多出院后获得及时、全面的跌倒评估的障碍。我们将追求以下目标测试和进一步完善 GAPcare 干预措施的具体目标： (1) 审查招募和招募的可行性将符合条件的患者保留到 GAPcare 干预中，(2) 确定 GAPcare 的初始疗效干预以减少后续跌倒和 6 个月时的医疗保健利用率。这将告知效应大小以及后续研究的样本量计算，以及（3）征求医生和患者的反馈他们对 GAPcare 干预的满意度。此次调查预计有两个主要内容贡献： 1. 我们将收集有关可行性、初步效果的信息，并征求反馈意见 GAPcare 干预，这将有助于完善我们后续研究的方法，并且 2. Goldberg 博士将接受培训和初步数据，以向国家研究所提交更大规模的研究作为 K 奖老化。这种干预措施对公共卫生具有巨大意义，因为跌倒是导致死亡和死亡的主要原因老年人的非致命性伤害，并且不存在指导 ED 管理人员和患者的协作护理模式其他利益相关者以减少随后跌倒的发生。这个提议非常具有创新性，因为与其他基于社区的计划不同，它针对的是在此期间急诊室中风险最高的老年人跌倒后，患者最容易再次跌倒，并且高度投入护理。