Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive Care

远程医疗增强重症监护后以患者为中心的康复轨迹

• 批准号: 10667691
• 负责人: Leanne M Boehm
• 金额: $ 82.86万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667691
• 关键词: Acceleration; Acute respiratory failure; Address; Adult; Affect; Age; Alzheimer' s disease related dementia; Attention; Behavior; COVID-19 pandemic; Caregivers; Caring; Clinic; Clinic Visits; Clinical; Cognition; Cognitive; Cohort Studies; Complex; Control Groups; Critical Illness; Data; Dementia; Development; Employment; Evaluation; Family member; Financial Hardship; Goals; Healthcare; Home; Hospitals; Impaired cognition; Impairment; Independent Living; Institution; Intensive Care; Intensive Care Units; International; Intervention; Intervention Studies; Knowledge; Link; Long-Term Effects; Measurement; Measures; Mental Depression; Mental Health; Methods; Modeling; Monitor; Morbidity - disease rate; Outcome; Outcome Measure; Oxygen; Patients; Persons; Population; Prevalence; Process; Provider; Psyche structure; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Research; Resources; Risk; Sampling; Schedule; Self Management; Septic Shock; Services; Severities; Site; Social Network; Societies; Specialist; Structure; Survivors; Syndrome; Technology; Telemedicine; Testing; Time; Travel; Unemployment; Visit; Work; age stratification; blind; care delivery; clinical care; cognitive function; cognitive skill; cohort; collaborative care; comparison control; cost; design; disability; effective intervention; efficacy evaluation; efficacy study; evidence base; experience; follow-up; health care service utilization; hospital readmission; improved; indexing; patient oriented; peer; physical conditioning; primary outcome; programs; recovery services; retiree; rural area; secondary outcome; sepsis induced ARDS; social; social integration; socioeconomics; standard of care; survivorship; telehealth; trial comparing; uptake

Approximately 33-50% of intensive care unit (ICU) survivors develop long-term cognitive impairment – a well-established form of Alzheimer’s Disease Related Dementia (ADRD). ICU-acquired ADRD prevalence is especially high in acute respiratory distress syndrome and sepsis survivors, affecting up to 80%. This loss of cognition leads to loss of independence, employment, and quality of life and persists for months to years. ICU-acquired ADRD is part of a broader syndrome known as Post-Intensive Care Syndrome (PICS), including physical, mental, and socioeconomic impairments. ICU Recovery Clinics (ICU-RC) are a feasible and promising intervention to collaboratively address ICU-acquired ADRD and other PICS impairments, but in-person access is limited. There is a need to study efficacy of ICU-RCs with large cohorts using alternative delivery strategies to expand availability and reach. Older (age >=45) septic shock and/or acute respiratory failure patients are at a combined risk for ICU-acquired ADRD among other impairments, and the ideal population to first address this knowledge gap. The Vanderbilt ICU Recovery Center team has nearly 10 years of experience providing interdisciplinary, collaborative care to identify and treat ICU-acquired ADRD and other PICS impairments experienced by ICU survivors. We hypothesize that a collaborative telemedicine-delivered interdisciplinary ICU-RC intervention effectively identifies and improves long-term cognitive function, and as secondary outcomes, physical and mental health function, social integration, and self-management behaviors vs. a control condition with follow-up chosen by the discharge team. Therefore, in a sample of older septic shock and acute respiratory failure survivors, we aim to examine the efficacy of telemedicine ICU-RC services vs. control follow-up chosen by the discharge team in identifying and managing ICU-acquired ADRD and other PICS impairments (i.e., physical, mental health, social, self-management function) at 6 months after hospital discharge. We will address our hypothesis and aims by conducting a controlled trial of 202 patients randomized 1:1 with age stratification to telemedicine ICU-RC or control (101 per group). Telemedicine recipients will receive a minimum of 2 ICU-RC visits within 3 months of hospital discharge or return to home if discharged to another institution, with additional follow-up determined by the severity of PICS impairment. Our primary outcome is cognitive function (Aim 1) at 6 months using the MoCA-Blind and PROMIS Cognitive Function from the Long-term Core Outcome Measurement Set for ICU survivors. Our secondary outcomes are physical and mental health functioning (Aim 2) and social integration and self-management behaviors (Aim 3). In addition to 6-month measurements, we will assess pre-hospital function and 1-week post-discharge to assess discharge functional trajectories. This research will provide scientific justification for the continued development, implementation, and scaling of ICU recovery programs. Ultimately, such knowledge can improve the quality of life for millions of ICU survivors and family members by reducing ADRD burden.

重症监护病房（ICU）浮雕的大约33-50％发展了长期认知障碍 - 这是阿尔茨海默氏病有关的痴呆症（ADRD）的公认形式。 ICU获得的ADRD患病率在急性呼吸窘迫综合征和败血症生存中尤为高，影响高达80％。这种认知的丧失导致几个月到数年的独立性，就业和生活质量和持续存在。 ICU获得的ADRD是一种更广泛的综合征的一部分，称为强化后护理综合征（PICS），包括身体，精神和社会经济障碍。 ICU恢复诊所（ICU-RC）是可行且承诺的干预措施，可协作解决ICU获得的ADRD和其他图片障碍，但面对面的访问有限。有必要使用替代交付策略来扩大可用性和覆盖范围的替代交付策略，研究ICU-RC的效率。年龄较大（年龄> = 45）败血性休克和/或急性呼吸衰竭患者在其他障碍中具有ICU获得ADRD的综合风险，并且是首先解决此知识差距的理想人群。范德比尔特ICU恢复中心团队拥有将近10年的经验，提供跨学科的协作护理，以识别和治疗ICU幸存者经历的ICU获得的ADRD和其他图片障碍。我们假设，协作远程医疗跨学科的ICU-RC干预有效地识别并改善了长期认知功能，并且随着次要结果，身体和心理健康功能，社会融合以及自我管理行为以及由遣送团队选择的跟进条件。因此，在较旧的败血性休克和急性呼吸衰竭存活样本中，我们旨在检查远程医疗ICU-RC服务与出院团队在住院后6个月后6个月后6个月内识别和管理ICU获得的ADRD和其他图片障碍（即身心健康，心理健康，社交，自我管理功能）在识别和管理ICU获得的ADRD和其他图片障碍（即进行ICU获得的ADRD）方面的有效性。我们将通过对202名患者进行对照试验的对照试验来解决我们的假设，并将年龄分层与远程医疗ICU-RC或对照（每组101）进行对照试验。远程医疗接收者将在出院后的3个月内至少进行2次ICU-RC访问，或者如果被送往另一家机构，则将返回家中，并由图片障碍的严重程度确定了额外的随访。我们的主要结果是使用MOCA盲和Promis认知功能在ICU冲浪者的长期核心结果测量集中使用的MOCA盲和Promis认知功能在6个月时的认知功能（目标1）。我们的次要结果是身心健康功能（AIM 2）以及社会融合和自我管理行为（AIM 3）。除了6个月的测量值外，我们还将评估院前功能和1周的放电后，以评估放电功能轨迹。这项研究将为ICU恢复计划的持续开发，实施和规模提供科学理由。最终，这种知识可以通过减轻ADRD负担来改善数百万ICU冲浪者和家庭成员的生活质量。