ED GOAL: An Advance Care Planning Intervention for Seriously Ill Older Adults in the Emergency Department

ED 目标：针对急诊科重病老年人的预先护理计划干预

• 批准号: 10444068
• 负责人: Kei Ouchi
• 金额: $ 5.4万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10444068
• 关键词: Accident and Emergency department; Acute Disease; Address; Administrative Supplement; Advance Care Planning; Award; Behavior Therapy; Caregivers; Caring; Clinical; Clinical Trials; Computerized Medical Record; Consumption; Development; Doctor of Philosophy; Documentation; Elderly; Emergency Department Physician; Emergency Medicine; Ensure; Environment; Family; Foundations; Funding; Future; Geriatrics; Goals; Gunshot wound; Hand; Health Services Research; Home; Hospitals; Impaired cognition; Inpatients; International; Intervention; Lead; Medical emergency; Mentors; Nurses; Outpatients; Palliative Medicine; Parents; Patient Self-Report; Patient-Centered Care; Patients; Physicians; Pragmatic clinical trial; Preparation; Productivity; Randomized Controlled Trials; Research; Research Personnel; Resource-limited setting; Scientist; Time; Training; Woman; acceptability and feasibility; acute care; base; care coordination; career development; end of life care; implementation science; improved; medical schools; motivational enhancement therapy; patient engagement; pressure; standard of care

K76 Administrative Supplement Application Project Summary/Abstract This is an administrative supplement to the parent award (K76AG064434) of Kei Ouchi, MD, MPH, MS, which will ensure continued productivity during his family medical emergency and will not change the scope of the parent award. Dr. Ouchi is committed to lead the field of emergency medicine to integrate the principles of geriatrics and palliative medicine. Dr. Ouchi is an emergency physician and home hospital physician (provides inpatient-level care at patient's home1) in the Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School. Dr. Ouchi's research focuses on the development of ED GOAL, a 6-minute motivational interview conducted in the emergency department (ED), which engages patients to address advance care planning (ACP) conversations with their outpatient clinicians and avoids a time-consuming, sensitive conversation in the time-pressured ED environment. With funding from the NIA GEMSSTAR R03 and Emergency Medicine Foundation, Dr. Ouchi developed ED GOAL and demonstrated its acceptability and feasibility in seriously ill older adults in the ED. ED GOAL may also increase patients' self-reported ACP engagement and ACP documentation after leaving the ED. The GEMSSTAR project identified that, in this setting where resources are limited, ED GOAL requires refinements to maximize its potential efficacy. This study will refine ED GOAL to maximize its potential efficacy and scalability, and determine the preliminary efficacy of the refined ED GOAL to increase ACP engagement one month after leaving the ED. The proposed 5-year training plan accelerates Dr. Ouchi's career development as an independent physician-scientist through training in: 1) cognitive impairment assessment and engagement of caregivers in ACP research (ED GOALCG); 2) adaptation of ED GOAL/ ED GOALCG by specially-trained nurses; 3) conducting a clinical trial of ED GOAL/ ED GOALCG administered by specially-trained nurses; and 4) implementation science in preparation for a future pragmatic clinical trial of ED GOAL/ ED GOALCG. James Tulsky, MD, an internationally recognized leader in palliative medicine, will serve as the primary mentor. Dr. Ouchi is co-mentored by: 1) Mara Schonberg, MD, MPH, a leader in health services research among older adults; and 2) Edward Boyer, MD, PhD, a K24-funded emergency medicine researcher with expertise in behavioral interventions. The ultimate goal is to establish ED GOAL as a national standard of care to help all seriously ill older adults to receive ACP conversations at the most critical times of their lives. Dr. Ouchi aims to expand the scope of ED-based care from acute, disease-oriented care (e.g., gunshot wounds) to include patient- centered care (e.g., value-based, end-of-life care) for seriously ill older adults by integrating geriatrics and palliative medicine principles.

K76行政补充申请 项目概要/摘要 这是对 Kei Ouchi 医学博士的家长奖 (K76AG064434) 的行政补充， MPH、MS，这将确保他的家庭医疗紧急情况期间的持续生产力 并且不会改变家长奖励的范围。大内博士致力于引领该领域 急诊医学整合了老年医学和姑息医学的原则。大内博士是 急诊医生和家庭医院医生（在患者身边提供住院级别的护理 家 1) 哈佛大学布莱根妇女医院急诊科 医学院。 Ouchi 博士的研究重点是 ED GOAL 的开发，即 6 分钟 在急诊科 (ED) 进行的动机访谈，让患者参与 与门诊临床医生进行预先护理计划 (ACP) 对话，并避免 在时间紧迫的 ED 环境中进行耗时且敏感的对话。资金来自 NIA GEMSSTAR R03 和急诊医学基金会，Ouchi 博士开发了 ED GOAL 并证明了其在急诊室重病老年人中的可接受性和可行性。教育目标 还可能增加患者离开后自我报告的 ACP 参与度和 ACP 记录 急诊室。 GEMSSTAR 项目发现，在资源有限的情况下，ED GOAL 需要改进以最大限度地发挥其潜在功效。这项研究将把 ED 目标细化为 最大限度地发挥其潜在功效和可扩展性，并确定精制后的初步功效 ED 的目标是在离开 ED 一个月后增加 ACP 参与度。拟议的5年 培训计划加速大内博士作为独立医师科学家的职业发展 通过以下方面的培训：1) 认知障碍评估和护理人员参与 ACP 研究（ED GOALCG）； 2) 由经过专门培训的护士调整 ED GOAL/ED GOALCG； 3） 由经过专门培训的护士进行 ED GOAL/ ED GOALCG 的临床试验；和 4) 实施科学，为未来 ED GOAL/ ED 的实用临床试验做准备 目标ALCG。国际公认的姑息医学领域的领导者 James Tulsky 医学博士将担任 作为主要导师。 Ouchi 博士的共同指导者是： 1) Mara Schonberg，医学博士、公共卫生硕士，该领域的领导者 老年人保健服务研究； 2) Edward Boyer，医学博士、博士，K24 资助的 急诊医学研究员，具有行为干预方面的专业知识。最终目标是 将 ED GOAL 确立为国家护理标准，帮助所有重病老年人接受治疗 ACP 在人生最关键时刻的对话。大内博士的目标是扩大研究范围 基于急诊室的护理，从急性、以疾病为导向的护理（例如枪伤）到包括患者 通过整合对重病老年人的集中护理（例如基于价值的临终护理） 老年病学和姑息医学原则。