Medication Management During Hospital-to-Home Transitions of Older Adults with Alzheimer's Disease and Related Dementias (ADRD)

患有阿尔茨海默病和相关痴呆症 (ADRD) 的老年人从医院到家庭过渡期间的药物管理

• 批准号: 9914197
• 负责人: Alicia Ines Arbaje
• 金额: $ 16.38万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914197
• 关键词: Address; Adverse event; Alzheimer' s disease related dementia; Area; Behavioral; Behavioral Model; Caregivers; Caring; Discipline of Nursing; Disease; Effectiveness; Elderly; Elements; Engineering; Evaluation; Face; Foundations; Future; General Population; Goals; Health; Health Personnel; Health Services; Health system; Healthcare; Home environment; Hospitals; Human; Intervention; Interview; Medication Errors; Medication Management; Movement; Nursing Services; Participant; Patient Care; Patients; Persons; Pharmaceutical Preparations; Physical environment; Population; Principal Investigator; Process; Provider; Regimen; Rehabilitation therapy; Research; Research Personnel; Risk; Role; Safety; Shapes; Structure; System; Testing; Time; United States National Institutes of Health; Variant; Visit; Visiting Nurse; Work; care recipients; design; diaries; ergonomics; expectation; experience; health care settings; high risk; improved; informal caregiver; multidisciplinary; novel; patient safety; therapy development; tool

Care transitions are the movement of a person from one healthcare setting to another. The hospital-to-home transition is a high-risk period, especially for medication errors and adverse events and for persons with Alzheimer's disease and related dementias (ADRD). There is relatively little research to guide care transition improvement efforts for the ADRD population. An area of particular risk for older adults with ADRD during the hospital-to-home transition is role ambiguity regarding medication management (MM). Role ambiguity in MM occurs when the roles of older adults with ADRD, informal caregivers, and healthcare providers remain without a clear definition of who is responsible for completion of MM-related tasks, such as medication reconciliation. The goal of the current proposal is to (1) identify issues related to role ambiguity regarding medication management that threaten the safety of older adults with ADRD during hospital-to-home transitions, and (2) engage stakeholders to develop a set of strategies specific to ADRD to decrease role ambiguity and support MM during this high-risk transition. Specific Aim 1: Identify critical tasks regarding medication management and categorize factors shaping expectations for task distribution during hospital-to-home transitions of older adults with ADRD. We will develop process-flow diagrams of critical MM tasks and categorize factors shaping older adult and informal caregiver expectations for MM task distribution through (1) direct observations and interviews during initial home health visits of recently hospitalized older adults with ADRD and their informal caregivers; (2) photographs of objects used to support MM in the home; and (3) solicited participant diaries followed by post-diary semi- structured interviews with informal caregivers. Specific Aim 2: Identify and prioritize stakeholder strategies to manage expectations and distribute tasks to decrease role ambiguity and support successful medication management during hospital-to-home transitions. Guided by a participatory ergonomics approach from the field of human factors engineering, we will form an intervention refinement team (IRT) comprised of older adults with ADRD, informal caregivers, and healthcare providers involved in hospital-to-home transitions. The IRT will meet to use findings from the hospital- to-home process-flow diagram (Aim 1) to develop strategies and rate each strategy according to (1) importance to reducing role ambiguity, (2) likelihood of effectiveness in supporting MM, and (3) level of actionability. The long-term goal of our research is to develop, evaluate, and disseminate best practices to deliver optimal health care to older adults with ADRD in all stages of disease as they transition across healthcare settings. Completion of these aims will result in a stakeholder-informed set of strategies to support MM. Study findings will build a foundation for future work to develop and test a behavioral or technological solution to address unmet needs and safety risks during the hospital-to-home transition for older adults with ADRD.

护理过渡是一个人从一个医疗保健环境到另一个医疗保健的运动。医院到家 过渡是一个高风险时期，特别是对于药物错误和不良事件，对于 阿尔茨海默氏病和相关痴呆症（ADRD）。指导护理过渡的研究相对较少 改善了ADRD人口。在此期间，患有ADRD的老年人的风险特别风险 医院到家庭的过渡是药物管理（MM）的角色歧义。 MM的角色歧义 当具有ADRD的老年人，非正式护理人员和医疗保健提供者的角色时，就会发生 明确的定义是谁负责完成与MM相关的任务，例如药物对帐。 当前建议的目的是（1）确定与药物有关角色歧义有关的问题 在医院到家过渡期间威胁老年人的安全性的管理，（2） 吸引利益相关者制定一套针对ADRD的策略，以减少角色歧义和支持 在此高风险过渡期间的MM。 特定目的1：确定有关药物管理的关键任务并分类塑造因素 对ADRD老年人的医院到家过渡期间的任务分配期望。我们将 制定关键MM任务的过程流程图，并分类塑造老年人和非正式的因素 护理人员对MM任务分配的期望通过（1）在初始家中进行直接观察和访谈 最近住院的ADRD及其非正式护理人员的老年人的健康访问； （2）照片 用于支撑房屋中MM的对象； （3）征求参与者日记，然后是后半时 与非正式护理人员的结构化访谈。 特定目标2：确定并确定利益相关者的策略来管理期望和分发任务 降低角色歧义并支持医院到家中成功的药物管理 过渡。在人为因素工程领域的参与性人体工程学方法的指导下，我们将 组成由ADRD，非正式护理人员和 医疗保健提供者参与医院到家的过渡。 IRT将开会使用医院的发现 - 到家的过程流程图（目标1）以（1）重要性制定策略并对每个策略进行评分 降低角色歧义，（2）支持MM有效性的可能性，以及（3）可行水平。 我们研究的长期目标是开发，评估和传播最佳实践以提供最佳 在疾病的各个阶段，卫生保健在跨医疗机构过渡时，都会在各个疾病阶段。 这些目标的完成将导致一套支持MM的利益相关者的策略。研究结果 将为将来的工作建立基础，以开发和测试行为或技术解决方案以解决 ADRD老年人的医院到家过渡期间的未满足需求和安全风险。