Developing a PREPARE for Your Care delivery system to enhance adoption by healthcare organizations

开发 PREPARE for Your Care 交付系统以提高医疗机构的采用率

• 批准号: 10546110
• 负责人: David Farrell
• 金额: $ 25.8万
• 依托单位: PEOPLE DESIGNS, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10546110
• 关键词: Academic Medical Centers; Address; Adopted; Adoption; Advance Care Planning; Advance Directives; Aging; Agreement; California; Caring; Chronic Disease; Clinical; Communication; Communities; Companions; Complex; Copyright; County; County Hospitals; Data; Decision Making; Documentation; Elderly; Ensure; Event; Face; Feedback; Funding; Future; Geographic state; Goals; Health; Health system; Healthcare; Healthcare Systems; Hospitals; Individual; Interview; Language; Lead; Licensing; Linguistics; Measures; Medical; Medical Records; Methods; Modeling; Outcome; Pamphlets; Patients; Phase; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Preparation; Process; Public Health; Public Hospitals; Reach Effectiveness Adoption Implementation and Maintenance; Reduce health disparities; Reporting; Research; Small Business Innovation Research Grant; Surveys; System; Testing; Time; Translating; United States National Institutes of Health; Universities; advanced disease; base; care delivery; commercialization; community organizations; course development; design; end of life; evidence base; fifth grade; health care service organization; health disparity; health literacy; improved; informant; marginalized community; movie; novel; pilot test; preference; programs; prototype; satisfaction; skills; theories; tool; web site

PROJECT SUMMARY Background: The population is aging, chronic illness is increasing, and millions of older adults lack preparation for complex medical decision making, leading to uninformed decisions and care inconsistent with personal goals. The goal of advance care planning (ACP) is to ensure that patients receive medical care aligned with their goals and preferences. Our team has created the evidenced-based, interactive online PREPAREforYourCare.org (PREPARE) ACP program that helps English and Spanish-speaking individuals develop the skills to clarify their values, communicate their wishes, and make informed medical decisions. In trials, PREPARE helped 98% of English and Spanish-speaking older adults engage in ACP and increased documentation of ACP decisions in the medical record up to 43%. Since 2013, PREPARE has had over 350,000 unique users and the materials have been translated into multiple languages; yet reach and adoption by healthcare systems remains low due to burdensome licensing and purchasing complexity, packaging of PREPARE materials that may not meet organizations’ needs, and lack of guidance for how to integrate the materials into clinical workflows. The objective of this proposal is to develop, refine, and evaluate an adopter-focused PREPARE Delivery System (PDS) to ease the process of selecting, licensing, and implementing PREPARE within healthcare organizations. The goal is to improve adoption and profitability of PREPARE and to position the team to apply for Phase II SBIR funding to test adoption and implementation among varying types of healthcare and related organizations. Aim 1: We will determine what PREPARE assets (i.e., website, advance directives, pamphlets, videos), are wanted by healthcare organizations and how organizations want to access and license the assets. Aim 2: We will build a PDS prototype that includes the desired assets and addresses stakeholder barriers to licensing and implementation. Aim 3: We will determine the feasibility of the PDS by pilot testing among stakeholder potential adopters. Methods: We will conduct in-depth interviews with healthcare stakeholders from a wide range of potential adopting organzations including community-based hospitals, county hospitals, tertiary academic medical centers, and healthcare-based community organizations and analyze the data using qualitative content analysis (Aims 1 and 2). We will also assess feasibility and satisfaction with the PDS using validated surveys and in-depth interviews (Aim 3). We hypothesize that stakeholders will identify preferred PREPARE assets and barriers to adoption, continue to provide feedback on needed refinements of the PDS over the course of development, and report that the PDS is feasible and report high satisfaction with the deliveray system. Relevance to NIH and public health: Widespread adoption and implementation of the evidenced-based PREPARE program may reduce health disparities in ACP among culturally and linguistically diverse older adults. Expected Outcomes include a functional PDS prototype and preliminary data to apply for Phase II funding in which we will further develop and deploy the PDS and measure adoption and dissemination of the PREPARE program within healthcare systems.

项目摘要 背景：人口正在衰老，慢性病正在增加，数百万老年人缺乏准备 复杂的医疗决策，导致不知情的决策，并与个人目标不一致。目标 预先护理计划（ACP）是为了确保患者获得与目标和偏好保持一致的医疗服务。我们的 团队创建了基于证据的互动在线prepareforyourcare.org（准备）ACP计划 帮助英语和讲西班牙语的人发展技能，以阐明其价值，传达他们的愿望，并 做出明智的医疗决定。在试验中，准备帮助98％的英语和讲西班牙语的老年人参与 在ACP和医疗记录中ACP决策的记录中，高达43％。自2013年以来，准备已经 超过350,000个唯一用户和材料已转化为多种语言；尚未达到和收养 医疗保健系统由于耐磨和购买的复杂性而保持较低 可能无法满足组织需求的材料，并且缺乏如何将材料整合到临床上的指导 工作流程。该建议的目的是开发，完善和评估以采用者为中心的准备交付 系统（PDS）减轻在医疗机构中选择，许可和实施准备的过程。 目的是提高准备的采用和利润，并定位团队申请II阶段SBIR 资金以测试不同类型的医疗保健和相关组织中的采用和实施。目标1：我们会 医疗保健想要确定什么准备资产（即网站，预报指令，小册子，视频） 组织以及组织如何访问和许可资产。目标2：我们将构建一个PDS原型 包括所需的资产和地址许可和实施的利益相关者障碍。目标3：我们将确定 利益相关者潜在采用者中PDS的可行性。方法：我们将深入进行 与来自各种潜在的采用组织的医疗保健利益相关者的访谈，包括基于社区的组织 医院，计数医院，三级学术医疗中心和基于医疗保健的社区组织，并分析 使用定性内容分析的数据（目标1和2）。我们还将评估对PD的可行性和满意度 使用经过验证的调查和深入的访谈（AIM 3）。我们假设利益相关者将确定优先 准备采用资产和障碍，继续就PDS所需的改进提供反馈 开发过程，并报告PDS是可行的，并报告了对交付系统的高度满意。 与NIH和公共卫生的相关性：基于证据的准备的广泛采用和实施 计划可能会减少在文化和语言上的老年人中ACP的健康差异。预期的 结果包括功能性PDS原型和初步数据，以申请II期资金，我们将进一步 开发和部署PD并衡量医疗保健中准备计划的采用和传播 系统。