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

基本信息

批准号：
10455538
负责人：
Kei Ouchi
金额：
$ 24.22万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
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/10455538
关键词：
Accident and Emergency department Acute Disease Address Advance Care Planning Advance Directives Aging Alzheimer&apos s Disease Behavior Therapy Caregivers Caring Clinical Clinical Trials Computerized Medical Record Consultations Consumption Decision Making Dementia Development Doctor of Philosophy Documentation Elderly Emergency Department Physician Emergency Medicine Emergency Nursing Emergency department visit Ensure Environment Family Feedback Focus Groups Foundations Friends Funding Future Geriatric Nursing Geriatrics Goals Gunshot wound Hand Health Services Research Healthcare Home Hospitals Impaired cognition Inpatients International Intervention Interview K-Series Research Career Programs Knowledge Lead Life Life Extension Measures Medical Mentors Methods Modeling Nurses Nursing Faculty Nursing Research Outpatients Palliative Medicine Participant Patient Self-Report Patient-Centered Care Patients Physicians Pragmatic clinical trial Preparation Proxy Quality of Care Quality of life Randomized Controlled Trials Research Research Personnel Research Training Resource-limited setting Risk Scientist Signal Transduction Site Structure Surveys Targeted Research Testing Time Training Training Programs Venous Woman acceptability and feasibility acute care base care coordination career development caregiving design efficacy testing end of life care implementation science improved medical schools motivational enhancement therapy nursing intervention patient engagement pilot test pragmatic trial pressure primary outcome randomized controlled design secondary outcome sexual assault skills standard of care systematic review treatment arm treatment as usual

项目摘要

PROJECT SUMMARY This is a resubmission by Kei Ouchi, MD, MPH, MS for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76). 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 home10) 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 researcher and 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 culmination of this career development award will ensure that Dr. Ouchi gains the advanced research skills and knowledge that he needs to conduct a large, pragmatic trial of ED GOAL. 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.

项目概要这是 Kei Ouchi（医学博士、公共卫生硕士、理学硕士）为 Paul B. Beeson 新兴领导者职业生涯重新提交的内容老龄化发展奖（K76）大内博士致力于引领急诊医学领域的整合。大内医生是一名急诊科医生和家庭医院的老年病学和姑息医学原则。布里格姆急诊医学科医师（在患者家中提供住院级别的护理10） Ouchi 博士的研究重点是 ED GOAL 的开发，在急诊科 (ED) 进行的 6 分钟动机访谈，让患者参与解决护理计划 (ACP) 与门诊患者的提前对话，避免时间- 在 NIA 的资助下，在时间紧迫的 ED 环境中进行耗时、敏感的对话。 GEMSSTAR R03 和急诊医学基金会、Ouchi 博士开发了 ED GOAL 并展示了其急诊科重病老年人的可接受性和可行性也可能会提高患者的自我意识。离开 ED 后报告了 ACP 参与情况和 ACP 文档。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。本研究将完善 ED GOAL，以最大限度地发挥其潜在功效和可扩展性，并确定初步的改进后的 ED 目标在离开 ED 一个月后提高 ACP 参与度的有效性。为期 5 年的培训计划通过以下方式加速 Ouchi 博士作为独立医师科学家的职业发展培训：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改编 ED GOAL/ ED GOALCG； 3) 进行 ED GOAL/ 的临床试验； ED GOALCG 由经过专门培训的护士管理；4) 为未来做好准备的科学实施； ED GOAL/ ED GOALCG 的实用临床试验国际公认的研究员 James Tulsky 医学博士。姑息医学领域的领导者 Ouchi 博士将担任主要导师，并由以下人员共同指导：1) Mara。 Schonberg，医学博士、公共卫生硕士，老年人健康服务研究的领导者；2) Edward Boyer，医学博士、哲学博士，由 K24 资助的急诊医学研究人员，具有行为干预方面的专业知识。职业发展奖将确保大内博士获得他所学到的先进研究技能和知识需要对 ED GOAL 进行大规模、务实的试验，最终目标是将 ED GOAL 建立为一个国家护理标准，以帮助所有重病老年人最多接受 ACP 对话 Ouchi 博士的目标是扩大基于急诊科的护理范围，从急性、疾病到定向护理（例如枪伤）包括以患者为中心的护理（例如基于价值的临终护理）通过整合老年病学和姑息医学原则来治疗重病老年人。