ED GOAL: An Advance Care Planning Intervention for Seriously Ill Older Adults in the Emergency Department

ED 目标：针对急诊科重病老年人的预先护理计划干预

基本信息

批准号：
10455538
负责人：
Kei Ouchi
金额：
$ 24.22万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10455538
关键词：
Accident and Emergency department Acute Disease Address Advance Care Planning Advance Directives Aging Alzheimer&apos s Disease Behavior Therapy Caregivers Caring Clinical Clinical Trials Computerized Medical Record Consultations Consumption Decision Making Dementia Development Doctor of Philosophy Documentation Elderly Emergency Department Physician Emergency Medicine Emergency Nursing Emergency department visit Ensure Environment Family Feedback Focus Groups Foundations Friends Funding Future Geriatric Nursing Geriatrics Goals Gunshot wound Hand Health Services Research Healthcare Home Hospitals Impaired cognition Inpatients International Intervention Interview K-Series Research Career Programs Knowledge Lead Life Life Extension Measures Medical Mentors Methods Modeling Nurses Nursing Faculty Nursing Research Outpatients Palliative Medicine Participant Patient Self-Report Patient-Centered Care Patients Physicians Pragmatic clinical trial Preparation Proxy Quality of Care Quality of life Randomized Controlled Trials Research Research Personnel Research Training Resource-limited setting Risk Scientist Signal Transduction Site Structure Surveys Targeted Research Testing Time Training Training Programs Venous Woman acceptability and feasibility acute care base care coordination career development caregiving design efficacy testing end of life care implementation science improved medical schools motivational enhancement therapy nursing intervention patient engagement pilot test pragmatic trial pressure primary outcome randomized controlled design secondary outcome sexual assault skills standard of care systematic review treatment arm treatment as usual

Accident and Emergency department Acute Disease Address Advance Care Planning Advance Directives Aging Alzheimer&apos s Disease Behavior Therapy Caregivers Caring Clinical Clinical Trials Computerized Medical Record Consultations Consumption Decision Making Dementia Development Doctor of Philosophy Documentation Elderly Emergency Department Physician Emergency Medicine Emergency Nursing Emergency department visit Ensure Environment Family Feedback Focus Groups Foundations Friends Funding Future Geriatric Nursing Geriatrics Goals Gunshot wound Hand Health Services Research Healthcare Home Hospitals Impaired cognition Inpatients International Intervention Interview K-Series Research Career Programs Knowledge Lead Life Life Extension Measures Medical Mentors Methods Modeling Nurses Nursing Faculty Nursing Research Outpatients Palliative Medicine Participant Patient Self-Report Patient-Centered Care Patients Physicians Pragmatic clinical trial Preparation Proxy Quality of Care Quality of life Randomized Controlled Trials Research Research Personnel Research Training Resource-limited setting Risk Scientist Signal Transduction Site Structure Surveys Targeted Research Testing Time Training Training Programs Venous Woman acceptability and feasibility acute care base care coordination career development caregiving design efficacy testing end of life care implementation science improved medical schools motivational enhancement therapy nursing intervention patient engagement pilot test pragmatic trial pressure primary outcome randomized controlled design secondary outcome sexual assault skills standard of care systematic review treatment arm treatment as usual

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项目摘要

PROJECT SUMMARY This is a resubmission by Kei Ouchi, MD, MPH, MS for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76). Dr. Ouchi is committed to lead the field of emergency medicine to integrate the principles of geriatrics and palliative medicine. Dr. Ouchi is an emergency physician and home hospital physician (provides inpatient-level care at patient’s home10) in the Department of Emergency Medicine, Brigham and Women’s Hospital/Harvard Medical School. Dr. Ouchi’s research focuses on the development of ED GOAL, a 6-minute motivational interview conducted in the emergency department (ED), which engages patients to address advance care planning (ACP) conversations with their outpatient clinicians and avoids a time- consuming, sensitive conversation in the time-pressured ED environment. With funding from the NIA GEMSSTAR R03 and Emergency Medicine Foundation, Dr. Ouchi developed ED GOAL and demonstrated its acceptability and feasibility in seriously ill older adults in the ED. ED GOAL may also increase patients’ self- reported ACP engagement and ACP documentation after leaving the ED. The GEMSSTAR project identified that, in this setting where resources are limited, ED GOAL requires refinements to maximize its potential efficacy. This study will refine ED GOAL to maximize its potential efficacy and scalability, and determine the preliminary efficacy of the refined ED GOAL to increase ACP engagement one month after leaving the ED. The proposed 5-year training plan accelerates Dr. Ouchi’s career development as an independent physician-scientist through training in: 1) cognitive impairment assessment and engagement of caregivers in ACP research (ED GOALCG); 2) adaptation of ED GOAL/ ED GOALCG by specially-trained nurses; 3) conducting a clinical trial of ED GOAL/ ED GOALCG administered by specially-trained nurses; and 4) implementation science in preparation for a future pragmatic clinical trial of ED GOAL/ ED GOALCG. James Tulsky, MD, an internationally recognized researcher and leader in palliative medicine will serve as the primary mentor. Dr. Ouchi is co-mentored by: 1) Mara Schonberg, MD, MPH, a leader in health services research among older adults; and 2) Edward Boyer, MD, PhD, a K24-funded emergency medicine researcher with expertise in behavioral interventions. The culmination of this career development award will ensure that Dr. Ouchi gains the advanced research skills and knowledge that he needs to conduct a large, pragmatic trial of ED GOAL. The ultimate goal is to establish ED GOAL as a national standard of care to help all seriously ill older adults to receive ACP conversations at the most critical times of their lives. Dr. Ouchi aims to expand the scope of ED-based care from acute, disease- oriented care (e.g., gunshot wounds) to include patient-centered care (e.g., value-based, end-of-life care) for seriously ill older adults by integrating geriatrics and palliative medicine principles.

项目摘要这是医学博士Kei Ouchi，MPH，MPH，Paul B. Beeson新兴领导者职业生涯的重新提取衰老发展奖（K76）。 Ouchi博士致力于领导急诊医学领域以整合老年医学和姑息医学的原理。 Ouchi博士是急诊医师和家庭医院 Brightian（在患者家中提供住院水平的护理10）和妇女医院/哈佛医学院。 Ouchi博士的研究重点是ED目标的发展，急诊科（ED）进行了6分钟的动机访谈，该访谈使患者参与解决与门诊临床医生进行预先护理计划（ACP）对话，并避免时间 - 在耗时的ED环境中消耗，敏感的对话。有NIA的资金 Gemsstar R03和急诊医学基金会，Ouchi博士制定了ED目标并展示了其急诊室的重病老年人的可接受性和可行性。 ED目标也可能增加患者的自我离开ED后，报告了ACP参与和ACP文档。确定的Gemsstar项目在这种情况下，ED目标需要进行改进以最大程度地提高其潜在效率。这项研究将完善ED目标以最大化其潜在效率和可伸缩性，并确定初步的目标精制ED目标的功效是在离开ED后一个月增加ACP参与度。提议 5年的培训计划通过培训：1）护理人员在ACP研究中的认知障碍评估和参与度（ED Goarcg）； 2）由特殊训练的护士适应ED目标/ ED Goalcg； 3）进行ED目标的临床试验/ 由特殊训练的护士管理的ED Goarcg； 4）实施科学为未来做准备 ED目标/ ED Goalcg的务实临床试验。詹姆斯·塔尔斯基（James Tulsky），医学博士，国际认可的研究员姑息医学领导者将担任主要导师。 Ouchi博士是由：1）Mara的医学博士Schonberg，MPH，老年人卫生服务研究领导者； 2）医学博士爱德华·博耶（Edward Boyer）博士由K24资助的急诊医学研究人员具有行为干预方面的专业知识。这个的结晶职业发展奖将确保Ouchi博士获得他的高级研究技能和知识需要对ED目标进行大型务实的试验。最终目标是确定ED目标全国护理标准，以帮助所有重病老年人最多接受ACP对话他们生活的关键时期。 Ouchi博士旨在扩大急性疾病的基于ED护理的范围 - 定向护理（例如，枪伤）包括以患者为中心的护理（例如，基于价值的，临终关怀）通过整合老年医学和姑息医学原则，以重病的老年人。