GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare II：老年急性病

基本信息

批准号：
10515692
负责人：
Elizabeth Goldberg
金额：
$ 5.4万
依托单位：
RHODE ISLAND HOSPITAL
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：
2019-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10515692
关键词：
Accelerometer Accident and Emergency department Accreditation Acute Address Age Aging Apple watch Award Caregivers Caring Clinical Trials Communication Data Data Analyses Death Rate Devices Elderly Emergency Care Emergency Department patient Emergency Medicine Emergency department visit Epidemiologist Epidemiology Evaluation Failure Fall prevention Future Gait Goals Health Care Costs Health Policy Health Services Health Services Research Healthy People 2020 Home Impaired cognition Injury Intervention Intervention Studies Investigation Leadership Life Measures Medication Management Mentors Mentorship Methodology Methods Modeling Modification Monitor Morbidity - disease rate Outcome Outpatients Participant Patient Self-Report Patients Pattern Periodicity Persons Pharmaceutical Preparations Pharmacists Pharmacy facility Physicians Physiological Pilot Projects Policies Population Preparation Prevention Protocols Principal Investigator Process Measure Protocols documentation Proxy Public Health Qualitative Methods Qualitative Research Randomized Controlled Trials Recommendation Recurrence Rehabilitation therapy Research Research Personnel Resources Risk Factors Safety Sampling Scientist Series Specialist Standardization Technology Telephone Testing Time Training Work acceptability and feasibility acute care base care coordination care providers career collaborative approach digital health disability experience fall risk falls field study fitness follow-up health care service utilization high risk modifiable risk mortality multidisciplinary physical therapist prevent preventive intervention programs recruit response retention rate sensor treatment as usual uptake usability wearable device

项目摘要

PROJECT SUMMARY Falls by older adults are often predictable and preventable, yet there is a notable lack of research evaluating interventions to reduce the occurrence of recurrent falls in older adult Emergency Department (ED) patients. Dr. Goldberg’s Beeson K76 project GAPcare II, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, addresses this lack of research by further refining and examining the intervention she created in her GEMSSTAR R03 project. In this intervention, patients, caregivers, physical therapists (PTs), pharmacy specialists, and clinicians provide a patient-centric, collaborative approach to fall prevention that bridges the ED visit with outpatient resources. PTs evaluate geriatric patients in the ED immediately after their fall, perform a focused assessment of future fall risk and determine the safety of discharge home. Pharmacists in the ED perform a medication therapy management session aimed at reducing/tapering fall risk increasing medication. ED clinicians, patients and caregivers in turn incorporate the advice offered by these professionals before the patient leaves the ED. In her Beeson K76 GAPcare II project, Dr. Goldberg will build on the lessons learned from the GEMSSTAR R03 work. GAPcare II’s specific aims are to: (1) conduct field testing with geriatric patients with and without cognitive impairment and their caregivers to assess the feasibility, acceptability, and usability of the Apple Watch to objectively measure fall-related outcomes; (2) refine the GAPcare intervention and study protocol based on lessons learned and findings from the GEMSSTAR R03 GAPcare I pilot study and conduct a small open trial of the GAPcare II intervention; and (3) conduct a pilot randomized, controlled trial (RCT) of the GAPcare II (n=200) intervention to obtain initial estimates of efficacy of GAPcare II to decrease recurrent falls at 12 months relative to usual care. This investigation will provide Dr. Goldberg with critical pilot data and expertise to submit a R01 proposal to NIA for a full-scale, multi-center, comprehensive RCT. Dr. Goldberg’s Beeson K76 award overarching aims are to develop and test an ED-based and post-discharge protocol that reduces recurrent falls in older adults and to launch her physician-scientist career as an emerging leader in geriatric emergency medicine. To achieve this goal, Dr. Goldberg will obtain additional training in qualitative research, digital health, longitudinal data analysis, clinical trial methods, and leadership. This expertise will be achieved through advanced coursework, leadership training, and intensive interactions with her mentorship team. Her primary mentors, Dr. Roland Merchant, emergency medicine physician and epidemiologist, and Dr. Vincent Mor, health services researcher and health policy expert, will provide training in epidemiology, health services research, and leading policy initiatives. Her mentorship team also includes experts in qualitative research, digital health, rehabilitation measures, longitudinal data analysis, clinical trial methods, fall prevention and geriatric medication management.

项目概要老年人跌倒通常是可以预测和预防的，但缺乏值得注意的研究评估减少老年急诊科 (ED) 患者反复跌倒发生的干预措施。 Goldberg 博士的 Beeson K76 项目 GAPcare II，老年急性和急性后护理协调计划针对急诊科跌倒预防，通过进一步完善和解决研究不足的问题检查她在 GEMSSTAR R03 项目中创建的干预措施。护理人员、物理治疗师 (PT)、药剂专家和战士提供以患者为中心的、预防跌倒的协作方法将急诊室就诊与门诊资源评估联系起来。急诊科的老年患者跌倒后立即对未来跌倒风险进行重点评估，并确定出院回家的安全性。急诊室的药剂师进行药物治疗管理。会议旨在减少/逐渐减少急诊科牧师、患者和护理人员服用增加跌倒风险的药物。在患者离开急诊室之前，应采纳这些专业人员提供的建议。在她的 Beeson K76 GAPcare II 项目中，Goldberg 博士将借鉴 GEMSSTAR 的经验教训 R03 工作的具体目标是：（1）对有或没有的老年患者进行现场测试。认知障碍及其照顾者评估 Apple 的可行性、可接受性和可用性（2）完善GAPcare干预和研究方案基于 GEMSSTAR R03 GAPcare I 试点研究的经验教训和结果，并进行了一项小型研究 GAPcare II 干预措施的公开试验；以及 (3) 开展一项试点随机对照试验 (RCT) GAPcare II (n=200) 干预以获得 GAPcare II 减少复发性跌倒疗效的初步估计相对于常规护理 12 个月，这项调查将为 Goldberg 博士提供关键的试点数据和向 NIA 提交 R01 提案，进行全面、多中心、全面的随机对照试验。 Goldberg 博士的 Beeson K76 奖的首要目标是开发和测试基于 ED 的出院后减少老年人反复跌倒的方案，并作为新兴的医生科学家开启她的职业生涯为了实现这一目标，戈德伯格博士将接受以下方面的额外培训：定性研究、数字健康、纵向数据分析、临床试验方法和领导力。专业知识将通过高级课程、领导力培训以及与她的导师团队是急诊医学医师 Roland Merchant 博士和流行病学家、卫生服务研究员和卫生政策专家 Vincent Mor 博士将提供培训她的指导团队还包括流行病学、卫生服务研究和领先政策倡议。定性研究、数字健康、康复措施、纵向数据分析、临床试验专家方法、跌倒预防和老年用药管理。