Nursing Home Prevention of Injury in Dementia (NH PRIDE)

疗养院预防痴呆症伤害 (NH PRIDE)

基本信息

批准号：
9922194
负责人：
Sarah Dyer Berry
金额：
$ 52.01万
依托单位：
HEBREW REHABILITATION CENTER FOR AGED
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-05-01 至 2022-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9922194
关键词：
Accounting Address Adherence Administrator Alzheimer&apos s disease related dementia Area Behavior Caring Cessation of life Charge Clinical Communication Communities Community Healthcare Complex Consequentialism Data Data Set Dementia Dose Drug Prescriptions Drug usage Education Effectiveness Elderly Elements Emergency department visit Ensure Failure Fall prevention Family Fracture Future Goals Healthcare Systems Hospitalization Hyperglycemia Hypertension Injury Intervention Intervention Trial Knowledge Manuals Measures Medical Modeling Modification Monitor Nurses Nursing Homes Nursing Services Osteoporosis Outcome Outcome Measure Pain management Persons Pharmaceutical Preparations Phase Population Positioning Attribute Pragmatic clinical trial Prevention program Prevention strategy Process Measure Protocols documentation Provider Public Health Recommendation Research Resources Risk Risk Estimate Risk Factors Safety Scientist Service delivery model Services Standardization Syndrome System Testing Time Training Videoconferencing Visit base cardiometabolism care coordination care delivery care outcomes care systems case finding cost cost effective design effectiveness evaluation efficacy testing efficacy trial experience fall injury falls fracture risk functional decline functional status high risk implementation science improved injury prevention model design modifiable risk nonalzheimer dementia osteoporosis with pathological fracture post intervention pragmatic trial predictive modeling prevent prevention service primary outcome randomized trial remote location service intervention severe injury success therapy design

项目摘要

Abstract: Injurious falls are common, morbid, and costly for nursing home (NH) residents, particularly those with Alzheimer’s Disease and Related Dementias (ADRD). Our long-term goal is to reduce injurious falls in NH residents. The current proposal will develop an Injury Liason Service (ILS) intervention designed to promote deprescribing of psychoactive and cardiometabolic drugs AND encourage osteoporosis treatment. The intervention will address common barriers to fall prevention encountered in NH studies including fragmented communication. The following specific aims are proposed: 1) Develop an ILS care model designed to prevent injurious falls in NH residents using a) an automated risk calculator to identify high risk residents, b) centralized care coordination by an Injury Liaison Nurse, and c) videoconferencing with NH staff; 2) Test the ILS’ implementation-effectiveness in four NH facilities in residents with and without ADRD; and 3) Develop the protocol and resources for a phase 2 efficacy trial of the ILS model in 2-3 NH chains. The central hypothesis is that the ILS model will reduce injurious falls by changing care delivery through deprescribing and increased osteoporosis treatment. We hypothesize that implementation barriers are greater for residents with ADRD, and that it will require iterative intervention modifications to achieve adherence in this population. We will use experience-based co-design principles in Aim 1 to convene key stakeholders to transform the components of the intervention into a single, pragmatic care model that could be disseminated across NH systems. In Aim 2, we will implement the care model in four NH facilities. This will require programming the prediction model within the EMRs to identify high risk residents. A centralized ILS nurse will enact deprescribing recommendations and osteoporosis treatment among high risk residents (n~80) from a remote location. Videoconferencing will be used to facilitate education and communication. We will measure implementation success using post intervention measures of acceptability, demand, fidelity, and practicality. Effectiveness will be measured using process measures (e.g., medication dose reduction) using a pre-post design, and safety will be assessed using both pre-post measures from the Minimum Data Set (MDS) and chart review, stratified by ADRD status. In addition, we will validate the planned primary outcome for a future pragmatic trial, injurious falls ascertained from the MDS, with chart review. In Aim 3, we will develop the protocol and all materials needed for conducting an embedded pragmatic clinical trial of the ILS within 2-3 NH chains. The research team has considerable experience with NH research, including implementation science. At the completion of this study, we will have developed a robust care model that can be readily deployed by NH systems and evaluated for its impact on injurious falls in ADRD residents. We will be ideally positioned to conduct a pragmatic clinical trial embedded in NH systems to test the efficacy of the ILS. In addition to addressing injurious falls, this model has the potential to be modified for other complex geriatric syndromes in NH residents with ADRD.

抽象的：对于疗养院 (NH) 居民来说，跌倒伤害是常见的、病态的，而且代价高昂，尤其是那些患有老年痴呆症的人阿尔茨海默病和相关痴呆症 (ADRD) 我们的长期目标是减少新罕布什尔州的跌倒伤害。当前的提案将制定伤害联络服务 (ILS) 干预措施，旨在促进居民的健康。停用精神活性药物和心脏代谢药物并鼓励骨质疏松症治疗。干预措施将解决 NH 研究中遇到的预防跌倒的常见障碍，包括支离破碎的提出以下具体目标： 1) 开发旨在预防的 ILS 护理模型。使用 a) 自动风险计算器来识别高风险居民，b) 集中式处理 NH 居民的跌倒伤害由伤病联络护士进行护理协调，以及 c) 与 NH 工作人员进行视频会议 2) 测试 ILS；四个 NH 设施在有和没有 ADRD 的居民中的实施效果；以及 3) 制定在 2-3 个 NH 链中进行 ILS 模型 2 期疗效试验的方案和资源中心假设是。 ILS 模型将通过减少处方和增加护理来改变护理服务，从而减少伤害性跌倒我们努力解决患有 ADRD 的居民面临更大的实施障碍，以及我们将使用迭代干预修改来实现该人群的依从性。目标 1 中基于经验的协同设计原则，召集关键利益相关者来改造在目标 2 中，对可在 NH 系统中传播的单一、务实的护理模式进行干预。我们将在四个 NH 设施中实施护理模型，这将需要对预测模型进行编程。集中 ILS 护士将在 EMR 中识别高风险居民。偏远地区高危居民（n~80）的建议和骨质疏松症治疗。我们将使用视频会议来促进教育和沟通。使用可接受性、需求、保真度和实用性等干预后措施取得成功。通过使用前后设计的过程措施（例如药物剂量减少）和安全性进行测量将使用最小数据集 (MDS) 中的前后测量和图表审查进行评估，分层此外，我们将验证未来实用试验的计划主要结果，即有害。在目标 3 中，我们将制定方案和所有材料。研究团队需要在 2-3 个 NH 链内进行 ILS 嵌入式实用临床试验。在 NH 研究（包括实施科学）方面拥有丰富的经验。研究中，我们将开发出一个强大的护理模型，可以很容易地由 NH 系统部署并进行评估鉴于其对 ADRD 居民伤害性跌倒的影响，我们将处于理想的位置来进行务实的临床。嵌入 NH 系统以测试 ILS 功效的试验除了解决跌倒伤害问题外，还包括：该模型有可能针对患有 ADRD 的 NH 居民中的其他复杂老年综合征进行修改。