ED-LEAD: Emergency Departments LEading the transformation of Alzheimer's and Dementia care

ED-LEAD：急诊科引领阿尔茨海默病和痴呆症护理的变革

基本信息

批准号：
10709334
负责人：
Abraham Aizer Brody
金额：
$ 1044.22万
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/10709334
关键词：
Accident and Emergency department Address Advance Care Planning Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Behavioral Symptoms Bioinformatics Biometry Caring Case Management Characteristics Collaborations Communication Communities Dementia Development Effectiveness Elderly Emergency Care Emergency Situation Emergency department visit Emotional Engineering Ensure Event Family Friends Funding Goals Health Health system Home Home Health Agency Hospitalization Individual Intervention Logistics Medicine Mental Depression Methods Modeling Monitor Nurses Paramedical Personnel Participant Pathway interactions Patients Personal Satisfaction Persons Policies Population Population Heterogeneity Process Provider Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Research Research Personnel Resources Running Services Site Statistical Data Interpretation Stress Structure Surrogate Endpoint Telephone Testing Time United States National Academy of Sciences Variant Visit Vulnerable Populations Work care recipients clinical decision support comorbidity contextual factors data management dementia care design digital effectiveness study effectiveness testing ethnic diversity high risk hospice environment improved indexing intervention delivery mortality multi-site trial multidisciplinary novel primary outcome programs psychological symptom racial diversity therapy design usability

项目摘要

PROJECT SUMMARY In persons living with dementia (PLWD), an Emergency Department (ED) visit is a critical event and an opportunity to address the unmet needs that preceded the visit. Our multiple PI (mPI) team have together conducted cluster-randomized, multi-site trials in >50 EDs as well as multiple hospice and home health agencies, and are uniquely poised to address previous shortcomings in the development of scalable models of care for PLWD. Through this work, and that of our co-investigators, we have developed and tested three interventions relevant to PLWD and their care partners who visit the ED: 1) emergency care redesign (UH3AT009844) of new and intentional workflows for emergency providers reinforced by digital alerts and structured collaboration between sites, already shown to increase identification of advance care plans and enlisted multidisciplinary support; 2) a nurse-led telephonic care program (PCORI) that increased advance care planning and connected patients to hospice; and 3) a community paramedic-led structured coaching intervention (R01AG050504) that reduced the odds of an ED revisit within 30 days by 75%. Building on this evidence, the overarching goal of EDs LEading the Transformation of Alzheimer’s and Dementia Care (ED- LEAD) is to turn an ED visit from a crisis into an opportunity to improve the well-being of PLWD and their care partners. ED-LEAD will be embedded in a diverse group of 14 health systems, including 80 EDs with substantial racial and ethnic diversity, with the ED as the unit of randomization. An Administrative Core will oversee completion of all administrative milestones including integrating expertise and guidance from two NIA- funded networks and an External Advisory Board. An Implementation Core will: 1) harmonize core functions and processes; 2) optimize clinical decision support; and 3) and enable intervention fidelity across the three interventions. Finally, a Statistical Analysis Core will provide biostatistical and data management support. Our specific aims are to: 1) optimize a concurrently run emergency care redesign, nurse-led telephonic care, and community paramedic-led transitions intervention in PLWD for feasibility, fidelity and usability in two EDs; 2) study the effectiveness of these three interventions, alone and in combination, for PLWD with serious illness in a cluster-randomized multifactorial trial embedded within 80 EDs on: ED revisits, hospitalizations, and healthy days at home following the index ED visit; and 3) determine site, provider, patient, and care partner-level characteristics within a diverse population associated with variation in implementation of each intervention. ED- LEAD will address shortcomings noted in the National Academies of Sciences, Engineering, and Medicine report on PLWD by providing high-quality, real-world evidence that may improve the lives and reduce suffering of PLWD and their care partners. It will address key strategic goals of NIA and the National Alzheimer’s Plan to “implement and evaluate new care models to support effective care transitions”, and provide health systems with the necessary evidence to scale interventions for this vulnerable population.

项目摘要在患有痴呆症（PLWD）的人中，急诊科（ED）访问是一个关键事件，是解决访问之前未满足的需求的机会。我们的多个PI（MPI）团队在一起在> 50 eds以及多个临终关怀和家庭健康中进行了集群随附的多站点试验机构，并且被中毒是为了解决以前在开发可扩展模型的缺点照顾PLWD。通过这项工作以及我们的共同投资者的工作，我们已经开发并测试了三项与PLWD及其访问ED的护理合作伙伴有关的干预措施：1）紧急护理重新设计（UH3AT009844）由数字警报和网站之间的结构化协作，已经显示出来增加对预先护理计划的识别和招募多学科支持； 2）由护士领导的电话护理计划（PCORI）增加了进步护理计划并将患者互联到临终关怀； 3）社区领导的结构化教练干预措施（R01AG050504）在30天内将ED重新访问的几率降低了75％。基于此证据是EDS领导阿尔茨海默氏症和痴呆症护理转变的总体目标（Ed- 铅）是将危机的ED访问变成改善PLWD及其护理的福祉的机会合作伙伴。 ED-LEAD将嵌入14个卫生系统的潜水员组中，其中包括80 eD 大量的种族和种族多样性，急诊室是随机化的单位。行政核心将监督所有行政里程碑的完成，包括整合两个NIA-的专业知识和指导资助的网络和外部顾问委员会。实现核心将：1）协调核心功能和流程； 2）优化临床决策支持； 3）并在这三个中实现干预保真度干预措施。最后，统计分析核心将提供生物统计学和数据管理支持。我们的具体目的是：1）优化同时运行的紧急护理重新设计，由护士主导的电话护理以及社区护理人员主导的过渡干预PLWD，以实现两种EDS的可行性，忠诚度和可用性； 2）研究这三种干预措施的有效性，单独和组合，对患有严重疾病的PLWD 一项群集的多因素试验嵌入了80个EDS，ED重新审视，住院和健康在索引Ed访问之后在家的日子； 3）确定网站，提供者，患者和护理合作伙伴级别潜水员种群中与每种干预措施实施变化相关的特征。 ed- 铅将解决美国国家科学，工程和医学学院指出的缺点通过提供可改善生命并减少痛苦的高质量的现实证据，对PLWD的报告 PLWD及其护理伙伴。它将解决NIA和国家阿尔茨海默氏症计划的关键战略目标 “实施和评估新的护理模型以支持有效的护理过渡”，并提供卫生系统有必要的证据来扩展该脆弱人群的干预措施。