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.

护理过渡是指一个人从一种医疗保健环境转移到另一种医疗保健环境。从医院到家庭 过渡期是一个高风险期，尤其是用药错误和不良事件以及患有以下疾病的人 阿尔茨海默病和相关痴呆症（ADRD）。指导护理过渡的研究相对较少 ADRD 人群的改善努力。对于患有 ADRD 的老年人来说，这是一个特别危险的领域 从医院到家庭的过渡是药物管理 (MM) 方面的角色模糊。 MM 中的角色模糊 当患有 ADRD 的老年人、非正式护理人员和医疗保健提供者的角色仍然没有发挥作用时，就会发生这种情况。 明确定义谁负责完成 MM 相关任务，例如药物协调。 当前提案的目标是（1）确定与药物角色模糊相关的问题 在医院到家庭过渡期间威胁 ADRD 老年人安全的管理，以及 (2) 让利益相关者参与制定一套针对 ADRD 的战略，以减少角色模糊性并提供支持 MM在这个高风险的转变过程中。 具体目标 1：确定有关药物管理的关键任务并对影响因素进行分类 患有 ADRD 的老年人从医院到家庭过渡期间对任务分配的期望。我们将 绘制关键 MM 任务的流程图，并对影响老年人和非正式的因素进行分类 护理人员通过 (1) 初次回家期间的直接观察和访谈对 MM 任务分配的期望 对最近住院的 ADRD 老年人及其非正式护理人员进行健康访问； (2) 照片 家里用来支持MM的物品； (3) 征求参与者日记，然后是日记后半 对非正式护理人员进行结构化访谈。 具体目标 2：确定利益相关者策略并确定其优先顺序，以管理期望和分配任务 减少角色模糊性并支持从医院到家庭的成功药物管理 过渡。在人因工程学领域的参与式人体工程学方法的指导下，我们将 组建一个干预细化小组 (IRT)，由患有 ADRD 的老年人、非正式护理人员和 参与医院到家庭过渡的医疗保健提供者。 IRT 将开会利用医院的调查结果 - 到家流程图（目标 1），用于制定策略并根据 (1) 重要性对每个策略进行评级 减少角色模糊性，(2) 支持 MM 的有效性可能性，以及 (3) 可操作性水平。 我们研究的长期目标是开发、评估和传播最佳实践，以提供最佳的 为患有 ADRD 的老年人提供医疗保健服务，帮助他们在各个疾病阶段过渡到医疗机构。 完成这些目标将产生一套利益相关者知情的战略来支持 MM。研究结果 将为未来的工作奠定基础，开发和测试行为或技术解决方案来解决 患有 ADRD 的老年人从医院到家庭过渡期间未满足的需求和安全风险。