Emergency Care Redesign (ECR)

紧急护理重新设计 (ECR)

基本信息

批准号：
10709338
负责人：
JOSHUA CHODOSH
金额：
$ 207.58万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-15 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10709338
关键词：
Accident and Emergency department Address Adoption Advance Care Planning Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease test Area Caring Characteristics Collaborations Communication Communities Complex Consultations Delirium Dementia Drug Prescriptions Education Electronic Health Record Emergency Care Emergency Nursing Emergency Situation Emergency department visit Engineering Ensure Environment Ethnic Origin Face Feedback Goals Health Health Care Sector Health system Healthcare Systems Home Hospitalization Iatrogenesis Informatics Institutionalization Instruction Intervention Knowledge Lead Managed Care Programs Medicine Mental Depression Modeling Needs Assessment Notification Nurse Practitioners Nurses Outcome Paramedical Personnel Pathway interactions Patients Persons Physician Assistants Physicians Population Procedures Process Provider Psychological reinforcement Quality of life Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Resources Schedule Site Social Work Social Workers Specific qualifier value Structure Symptoms Telephone Testing Time Training United States United States National Academy of Sciences Variant Visit Work acute care care fragmentation care providers clinical decision support data acquisition dementia care deprivation design digital effective intervention effectiveness study effectiveness testing evidence base health inequalities implementation fidelity improved indexing multidisciplinary pragmatic intervention pressure primary outcome programs psychosocial response skills team-based care therapy design

项目摘要

PROJECT SUMMARY Persons living with dementia (PLWD) and their care partners visit the emergency department (ED) more frequently than those who are unaffected, and face unique and complex challenges associated with managing Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) and presenting symptoms. Team-based dementia care has worked well for PLWD, and an emergency care redesign intervention (UH3AT009844) of new and intentional workflows for emergency providers reinforced by digital alerts has increased advance care plans and enlisted multidisciplinary support. The psychosocial challenges and the inherent complexity of AD/ADRD care beg for a way to simplify a feasible assessment and ensure adoption of an emergency care team-based strategy. Simplifying an approach to reflect a less time-intensive and more pragmatic intervention while attending to needed knowledge, sensitivities, and a structure to achieve best care for PLWD and their care partners (dyads) requires three core components: 1) identifying problems; 2) prioritizing problems (inclusive of goals of care); and 3) establishing feasible, psychosocially sensitive interventions. While these components are essential to reduce ED revisits and other outcomes of critical importance to dyads, such results are unlikely without an embedded structure and an informatic-supported workflow that emphasizes and encourages care processes congruent with high-quality emergency care. The proposed intervention, Emergency Care Redesign, will provide core components of trial-tested dementia care management programs, embedded within an educational structure for emergency care providers (nurses, physicians, nurse practitioners, physician assistants, and social workers), clinical decision supports for PLWD notification, reminders and instructional brief videos for reinforcement, a shared structured worksheet in the electronic health record for critically needed assessments and data acquisition, audit and feedback supporting a biweekly case-review consultation, and a post visit social work phone call to reinforce community referrals for all PLWD who visit the ED. We will optimize, within one ED, this dementia-informed redesigned acute care (Emergency Care Redesign) and then implement this program in 40 out of 80 EDs within 14 health systems throughout the United States. We will test the effectiveness of emergency care redesign-informed procedures for the care of PLWD and care partners either as a single intervention or in combination with nurse-led telephonic care and/or a community paramedic-led transitions intervention in a cluster-randomized, multifactorial trial (in these 40 facilities) on the following outcomes: ED revisits within 30 days following the index visit, hospitalizations, and healthy days at home within 6 months of ED discharge. We will determine site, provider, patient, and care partner-level characteristics associated with fidelity of implementation and variation in impact of ED dementia-informed care. This intervention promises to reduce ED revisits while providing evidence-based, real-world care to improve the lives of PLWD with serious illness and their care partners.

项目摘要痴呆症（PLWD）及其护理伙伴的人访问急诊室（ED）通常比那些不受影响的人面临与管理相关的独特而复杂的挑战阿尔茨海默氏病和阿尔茨海默氏病有关的痴呆症（AD/ADRD）和呈现符号。基于团队的痴呆症护理在PLWD和紧急护理重新设计干预措施方面效果很好（UH3AT009844）由数字警报加强的紧急服务提供商的新的和有意的工作流程增加了预先护理计划并获得了多学科支持。社会心理挑战和 AD/ADRD护理的固有复杂性乞求一种简化可行评估并确保采用的方法基于紧急护理团队的策略。简化一种反映时间密集型和更多时间的方法务实的干预措施，同时参与所需的知识，敏感性和实现最佳护理的结构对于PLWD及其护理伙伴（二元组）需要三个核心组成部分：1）确定问题； 2）优先考虑问题（包括护理目标）； 3）建立可行的，心理敏感的干预措施。尽管这些组件对于减少ED重新访问和其他关键结果至关重要对于二元组来说，重要的结果不太可能没有嵌入结构和信息支持强调和鼓励与高质量紧急护理一致的护理过程的工作流程。这拟议的干预措施，紧急护理重新设计，将提供试验测试痴呆症护理的核心组成部分管理计划，嵌入到急诊提供者的教育结构中（护士，医师，护士从业人员，身体助理和社会工作者），PLWD的临床决策支持通知，提醒和教学简要视频，以加固，这是一个共享的结构化工作表迫切需要评估和数据获取，审核和反馈支持的电子健康记录每两周一次的案例审查咨询，并在后访问社会工作电话，以加强社区推荐所有参观ED的PLWD。我们将在一ed中优化这种痴呆症的重新设计的急性护理（紧急护理重新设计），然后在14个卫生系统中的80个ED中的40个ED中实施该计划整个美国。我们将测试紧急护理重新设计信息的有效性为了照顾PLWD和护理伙伴作为单一干预措施，或与护士领导的结合电话护理和/或社区护理人员主导的过渡干预措施，以群集随机，关于以下结果的多因素试验（在这40个设施中）：ED在30天内重新访问索引访问，住院和健康的日子在ED出院后6个月内。我们将确定站点，提供者，患者和护理合作伙伴级特征与实施和变化相关在ED痴呆症的影响中。这种干预措施有望减少ED重新审视，同时提供基于证据的现实世界，可以通过严重疾病及其护理伙伴来改善PLWD的生活。