Preparing older adults for major abdominal surgery: a systems engineering approach to implement preoperative comprehensive geriatric assessments

为老年人进行腹部大手术做好准备：实施术前综合老年评估的系统工程方法

• 批准号: 10643615
• 负责人: Julia Rose Berian
• 金额: $ 19.04万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-15 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643615
• 关键词: Abdomen; Aging; American; American College of Surgeons; Behavior Therapy; Caring; Cessation of life; Clinical; Clinical Trials; Cognition; Communities; Complex; Conduct Clinical Trials; Consensus; Data; Development; Dissemination and Implementation; Effectiveness; Elderly; Engineering; Environment; Equity; Eye; Fellowship; Focus Groups; Future; Geriatric Assessment; Goals; Guidelines; Health Professional; Health Services Research; Health protection; Health system; Healthcare; Hospitals; Impaired cognition; Incentives; Institution; Intervention; Interview; Knowledge; Length of Stay; Literature; Maps; Measures; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Methods; Minority; Modeling; Morbidity - disease rate; Multi-Institutional Clinical Trial; Muscle; National Institute on Aging; Operative Surgical Procedures; Patient-Focused Outcomes; Patients; Perioperative; Physical Function; Polypharmacy; Population; Population Heterogeneity; Positioning Attribute; Postoperative Complications; Postoperative Period; Practice Guidelines; Preparation; Process Assessment; Public Health; Quality of Care; Race; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Recovery of Function; Research; Resources; Risk; Risk Reduction; Rural; Site; Strategic vision; Surgical Specialties; System; Testing; Training; Underrepresented Populations; United States National Institutes of Health; Vulnerable Populations; Woman; Work; aging population; behavioral and social science; care delivery; care providers; career development; clinical care; community setting; contextual factors; design; effectiveness clinical trial; effectiveness-implementation RCT; effectiveness/implementation hybrid; effectiveness/implementation trial; evidence base; experience; functional disability; health care service utilization; health care settings; implementation design; implementation evaluation; implementation intervention; implementation science; implementation strategy; implementation study; implementation trial; improved; improved outcome; innovation; intervention delivery; meetings; men; mortality; multiple chronic conditions; novel; novel strategies; nutrition; older patient; patient oriented; patient safety; pilot test; preservation; prevent; programs; skills; social; surgical service; symposium; tool; uptake

PROJECT SUMMARY / ABSTRACT Older Americans are a growing segment of the population with an increasing need for surgical services, and they suffer a disproportionate burden of postoperative complications compared to their younger counterparts. There are opportunities to reduce risk and improve surgical care delivery for this vulnerable population. Preoperative comprehensive geriatric assessment (pCGA) optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social/environmental support; pCGA has been shown to decrease postoperative morbidity, mortality and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic centers. Systems-engineering and implementation science offer unique tools to reliably improve effective use of this important intervention. The goal of this proposal is to use systems-based engineering methods to tailor and pilot test a user-centered implementation package for the pCGA – one that can be adapted to community-based hospitals in preparation for a multi-site implementation trial. This work will promote equitable access to the pCGA, preserving effectiveness, protecting healthcare resources, and preventing avoidable morbidity and mortality. This goal aligns with the National Institute on Aging’s strategic vision C3 to “Support the development of behavioral interventions based on principles of basic behavioral and social science and designed with an eye to real-world implementation, in line with the NIH Stage Model.” My long-term goal is to improve surgical care for older adults through transdisciplinary research that promotes implementation and dissemination of effective, evidence-based, patient-oriented interventions. This 5-year K23 proposal will provide me with mentored research experience and formal training in implementation science, systems-engineering, clinical trials and aging research. With my strong background in surgical health services research, I am well positioned to conduct this project and transition to research independence, with the support of a team of expert mentors at an institution with an outstanding research environment. The proposed research aims are to: 1) Map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery 2) Co-design an implementation package for the pCGA applicable to a diverse population of older patients undergoing major abdominal surgery at (2a) a large academic hospital and (2b) an affiliate community site, and 3) Test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness trial. Upon completion of this project, I will have an adaptable, user-centered implementation package for pCGA with preliminary pilot data on implementation and effectiveness, which will serve as the basis for an R01 proposal to conduct a multi- site hybrid implementation-effectiveness clinical trial of the pCGA in older adults undergoing abdominal surgery.

项目摘要 /摘要 年长的美国人是越来越多的人口，对手术服务的需求越来越大， 与年轻的同龄人相比，他们的术后并发症的伯宁比例不成比例。 有机会降低风险并改善该脆弱人群的手术护理。 术前全面的老年评估（PCGA）优化了多种慢性条件和因素 通常在常规术前计划中忽略了，包括身体机能，多药，营养， 认知，心理健康和社会/环境支持；已显示PCGA可减少术后 各种外科专科的发病率，死亡率和住宿时间。尽管国家准则建议 PCGA的使用，缺乏战略指南的实施将其吸收限制为一些学术中心。 系统工程和实施科学提供了独特的工具来可靠地改善有效利用此 重要的干预。该建议的目的是使用基于系统的工程方法来量身定制和飞行员 测试PCGA以用户为中心的实现软件包 - 可以适应社区的 医院为多站点实施试验做准备。这项工作将促进公平访问PCGA， 保持有效性，保护医疗资源，并防止可避免的发病率和死亡率。 这个目标与国家老化战略愿景C3的国家研究所“支持发展的发展 基于基本行为和社会科学原则的行为干预措施，并设计 现实世界实现，符合NIH阶段模型。” 我的长期目标是通过跨学科研究改善老年人的外科手术护理 实施和传播有效的，基于证据的，以患者为导向的干预措施。这五年K23 提案将为我提供指导的研究经验和实施科学方面的正式培训， 系统工程，临床试验和衰老研究。我的手术卫生服务背景很强 研究，我有能力在支持下进行该项目并过渡到研究独立性 一个具有出色研究环境的机构的专家导师团队。 拟议的研究目的是：1）绘制PCGA流程并确定基于系统的障碍和促进器 它在接受大腹部手术的老年人中使用2） PCGA适用于（2A）A的大型腹部手术的潜水员人群 大型学术医院和（2B）会员社区站点，3）测试和完善PCGA实施 准备未来的随机对照实施效应试验。完成后 在这个项目中，我将为PCGA提供一个适应性的，以用户为中心的实现软件包，并具有初步飞行员 有关实施和有效性的数据，该数据将作为R01提案的基础 PCGA对腹部手术的老年人PCGA的现场混合实施效应临床试验。