Nurse Led Telephonic Care

护士主导的电话护理

基本信息

批准号：
10709339
负责人：
Abraham Aizer Brody
金额：
$ 247.91万
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/10709339
关键词：
Academy Accident and Emergency department Acute Address Advance Care Planning Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulatory Care Area Behavioral Symptoms Caring Case Management Cessation of life Characteristics Chronic Cluster randomized trial Communities Data Delirium Dementia Drug Prescriptions Effectiveness Emergency Care Emergency department visit Ensure Ethnic Origin Exclusion Health Health system Healthcare Systems Home Hospitalization Iatrogenesis Individual Inequity Institutionalization Intervention Intervention Trial Lead Medicare claim Medicine Modality Nurses Outcome Outpatients Pain Palliative Care Paramedical Personnel Patients Persons Population Population Heterogeneity Pragmatic clinical trial Procedures Process Provider Quality of Care Quality of life Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Reporting Site Surrogate Endpoint Telephone Testing Time United States Agency for Healthcare Research and Quality Variant Visit Work access disparities arm care coordination care fragmentation care systems comorbidity cost effective dementia care deprivation design effectiveness study effectiveness trial evidence base health care service utilization health equity health inequalities health plan implementation fidelity improved indexing novel pain symptom palliative patient oriented pragmatic trial primary outcome programs psychological symptom social social health determinants success symptom management user centered design

项目摘要

PROJECT SUMMARY The emergency department (ED) is often the care setting of last resort, and is ill suited to provide care for people living with dementia (PLWD) and their care partners. Many ED visits, which are for ambulatory-care- sensitive or acute exacerbations of chronic conditions, pain, behavioral and psychological symptoms of dementia (BPSD), and care partner strain are addressable if intervened upon in the community. Significant inequity in access to effective outpatient or home-based care further exacerbates who unnecessarily ends up in the ED. ED visits are also a significant indicator for serious illness in PLWD; 43.1% will have subsequent ED visits and 31.9% will die within one year. Telephonic nurse-led, interdisciplinary transitional and palliative care is a cost-effective, patient centered modality shown to both reduce inequities and ED visits. Studies in both palliative care populations and earlier stages of AD/ADRD without serious illness showed efficacy. However, this work has not focused on those living with Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD) who are also seriously ill, on large scale “real-world” embedded pragmatic clinical trials, or with a focus on the ED as site of triggering telephonic care. This project will implement Aliviado Dementia Care-Telephonic Edition, an evidence-based nurse-led telephonic transition and palliative care intervention tested end-to-end and widely disseminated in other modalities. The intervention will follow PLWD for 6-months, and focus on care transitions, assessing and managing BPSD, care partner strain, social determinants of health and social needs, and conversations about serious illness. In this study, the nurse-led telephonic intervention will first be optimized for use in conjunction with the two other interventions used in this proposal (ED Care Redesign and Community Paramedic-led Transitions) in two EDs to ensure effective coordination when multiple interventions are used. This optimization will follow a user-centered design process and engage a wide spectrum of stakeholders in coordination with administrative and implementation cores (Aim 1). We will then conduct a 3-arm embedded pragmatic multifactorial cluster randomized trial that uses Medicare claims data to test whether nurse-led telephonic care for PLWD alone and in concert with the other interventions reduces ED visits and hospitalizations, and increases the number of healthy days at home (Aim 2). We will implement the intervention in 40 EDs in the larger pragmatic trial, tested alone and in conjunction with the other interventions in a randomized fashion. We will also examine patient- and organization-level factors, including health inequities that influence implementation and PLWD- and care partner-reported outcomes as part of a separate implementation analysis (Aim 3). Upon successful completion, this study will provide stakeholders with the effectiveness data, as well as the implementation and PLWD-Care Partner dyad factors needed to provide this highly disseminable and implementable form of dyad-centered care with the potential to improve quality of care and quality of life, and reduce avoidable healthcare utilization in seriously ill PLWD.

项目概要急诊科 (ED) 通常是最后手段的护理机构，不适合为以下患者提供护理痴呆症患者 (PLWD) 及其护理伙伴多次就诊，进行门诊护理。慢性病、疼痛、行为和心理症状的敏感或急性恶化如果在社区进行重大干预，痴呆症（BPSD）和护理伙伴压力是可以解决的。在获得有效的门诊或家庭护理方面的不平等进一步加剧了不必要的后果急诊科就诊也是 PLWD 患有严重疾病的一个重要指标；43.1% 的患者随后会患上急诊科。电话护士主导的跨学科过渡和姑息治疗将导致 31.9% 的患者在一年内死亡。是一种具有成本效益、以患者为中心的方式，表明可以减少不平等和急诊就诊。然而，姑息治疗人群和早期 AD/ADRD 阶段（无严重疾病）显示出疗效。这项工作并不关注那些患有阿尔茨海默病和阿尔茨海默病相关疾病的人患有严重疾病的痴呆症（AD/ADRD），在大规模“真实世界”嵌入式实用临床试验中，或重点关注急诊室作为触发电话护理的场所该项目将实施 Aliviado 痴呆症。护理电话版，基于证据的护士主导的电话过渡和姑息治疗干预该干预措施将在 PLWD 后进行为期 6 个月的端到端测试并以其他方式广泛传播。并重点关注护理过渡、评估和管理 BPSD、护理伙伴压力、护理的社会决定因素健康和社会需求，以及有关严重疾病的对话在这项研究中，由护士主导的电话。干预措施将首先进行优化，以便与本提案中使用的其他两项干预措施结合使用（急诊科护理重新设计和社区护理人员主导的过渡）在两个急诊室进行，以确保有效协调当使用多种干预措施时，这种优化将遵循以用户为中心的设计流程并参与。广泛的利益相关者与行政实施和核心进行协调（目标 1）。然后进行一项使用医疗保险索赔的三组嵌入式实用多因素整群随机试验测试护士主导的电话护理是否单独针对 PLWD 以及与其他干预措施相结合的数据 ED 减少就诊和住院，并增加在家中保持健康的天数（目标 2）。在更大规模的实用试验中对 40 名急诊室实施干预措施，单独进行测试并与其他试验结合进行测试我们还将以随机方式检查患者和组织层面的因素，包括影响实施以及 PLWD 和护理合作伙伴报告的结果的健康不平等，作为成功完成后，本研究将为利益相关者提供单独的实施分析（目标 3）。与有效性数据，以及实施和 PLWD-Care 合作伙伴二元因素所需提供这种高度传播和可实施的以夫妻为中心的护理形式，有可能改善护理质量和生活质量，并减少重病 PLWD 中可避免的医疗保健利用率。