Improving Primary Care Clinicians’ Advance Care Planning for Persons Living with Alzheimer’s Disease and Related Dementias

改善初级保健临床医生对阿尔茨海默病和相关痴呆症患者的预先护理计划

• 批准号: 10670480
• 负责人: Christine E Kistler
• 金额: $ 38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670480
• 关键词: Address; Administrator; Adoption; Advance Care Planning; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Assisted Living Facilities; Attention; Black Populations; Black race; Cardiology; Caregivers; Caring; Cessation of life; Clinic; Clinical; Clinical Research; Clinical Trials; Communication; Communities; Consolidated Framework for Implementation Research; Dementia; Dementia caregivers; Diagnosis; Documentation; Elderly; Emergency department visit; Ensure; Evaluation; Family; Family member; Feedback; Goals; Healthcare; Healthcare Systems; Hospitalization; Integrated Health Care Systems; Intervention; Interview; Length of Stay; Life; Measures; Medical; Medicare; Mission; Modeling; National Institute on Aging; Nurses; Nursing Homes; Oncology; Online Systems; Outcome; Outcome Measure; Outpatients; Palliative Care; Patient Care Team; Patients; Persons; Physicians; Population; Population Heterogeneity; Positioning Attribute; Primary Health Care; Process; Proctor framework; Progressive Disease; Provider; Public Health; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Design; Sampling; Social Workers; Specific qualifier value; Survey Methodology; Surveys; Terminal Disease; Testing; Time; Training and Education; Treatment Efficacy; United States National Institutes of Health; Variant; Work; beneficiary; clinical care; clinical data warehouse; community living; decision-making capacity; dementia care; design; effectiveness trial; efficacy outcomes; evidence base; experience; group intervention; health care service utilization; health disparity; hospice environment; implementation evaluation; implementation outcomes; improved; medical specialties; minority communities; neurodegenerative dementia; operation; portability; post intervention; preference; primary outcome; secondary analysis; secondary outcome; skills; surrogate decision maker; treatment as usual; trial comparing; web site

PROJECT SUMMARY/ABSTRACT Advance care planning (ACP) is difficult for all older adults, but dementia makes ACP even more difficult. Alzheimer's disease and Alzheimer's disease related neurodegenerative dementias (AD/ADRD) are incurable, progressive and terminal diseases with unparalleled impact on the US healthcare system, patients and families. Over 5 million Americans live with AD/ADRD, and people with AD/ADRD lose decision-making capacity years in advance of critical and serious medical illness. Clinicians must discern when and how people with AD/ADRD can express valid treatment preferences at all stages of AD/ADRD. Additionally, significant disparities exist for people with AD/ADRD in minority communities. Most people with AD/ADRD are managed by their primary care clinics whose primary care teams receive little education and training on dementia management, and no attention to dementia-specific ACP communication needs. Primary care teams, including physicians, advance practice providers, nurses and social workers, are well-positioned to empower people living with AD/ADRD (PLwD) and their families in ACP, especially minority communities, yet lack critical dementia-specific communication skills. Evidence-based ACP interventions for PLwD are rare, and no prior clinical trial addresses AD/ADRD ACP in primary care with a focus on health disparities in Black PLwD. Our experienced investigative team has demonstrated feasibility and preliminary efficacy of an AD ACP practice improvement toolkit (AD ACP toolkit) for primary care teams. We will test whether our AD ACP toolkit will enable primary care teams to better conduct GOC discussions more efficiently and thus increase the number of GOC discussions held as compared to controls. We will deliver the AD ACP toolkit to 10 intervention primary care clinics and usual care to 10 control clinics with large Black populations within a large integrated health care system. Our first aim is to conduct a trial comparing the AD ACP Toolkit to usual care on goals of care discussions and other ACP measures (N=600). We will conduct stratified analyses for Black PLwD. The second aim is to examine the 18-month healthcare utilization outcomes for all PLwD served by intervention vs control clinics and conduct secondary analyses for Black PLwD. Lastly, we will assess implementation via surveys in the intervention clinics (N=120) followed by interviews (N=60) to understand any disparities in ACP for Black PLwD. This project addresses National Institute on Aging's mission to improve care for older adults with AD/ADRD in primary care. This work will improve how to incorporate ACP approaches for aging-related conditions by primary care teams and may be adaptable to other outpatient specialties such as oncology or cardiology.

项目概要/摘要 预先护理计划 (ACP) 对于所有老年人来说都很困难，但痴呆症使 ACP 变得更加困难。 阿尔茨海默病和阿尔茨海默病相关的神经退行性痴呆（AD/ADRD）是无法治愈的， 进行性疾病和晚期疾病对美国医疗保健系统、患者和家庭产生了无与伦比的影响。 超过 500 万美国人患有 AD/ADRD，患有 AD/ADRD 的人在数年内就会丧失决策能力 严重和严重疾病的进展。临床医生必须辨别 AD/ADRD 患者何时以及如何能够 表达 AD/ADRD 各个阶段的有效治疗偏好。此外，人与人之间存在着巨大的差异 少数族裔社区患有 AD/ADRD。大多数 AD/ADRD 患者由初级保健诊所管理 其初级保健团队很少接受有关痴呆症管理的教育和培训，也没有关注 痴呆症特定的 ACP 沟通需求。初级保健团队，包括医生，先进的实践 提供者、护士和社会工作者，有能力为 AD/ADRD 患者 (PLwD) 和 他们在 ACP 的家人，尤其是少数族裔社区，却缺乏针对痴呆症的关键沟通技巧。 针对 PLwD 的基于证据的 ACP 干预措施很少见，并且之前没有针对 AD/ADRD ACP 的临床试验 初级保健，重点关注黑人 PLwD 的健康差异。我们经验丰富的调查团队 证明了 AD ACP 实践改进工具包（AD ACP 工具包）的可行性和初步功效 初级保健团队。我们将测试我们的 AD ACP 工具包是否能让初级保健团队更好地开展工作 与之前相比，GOC 讨论更加高效，从而增加了 GOC 讨论的数量 控制。我们将向 10 个干预初级保健诊所提供 AD ACP 工具包，并向 10 个对照诊所提供常规护理 在大型综合医疗保健系统内拥有大量黑人人口的诊所。我们的首要目标是进行试验 将 AD ACP 工具包与常规护理的护理讨论目标和其他 ACP 措施进行比较 (N=600)。 我们将对黑人 PLwD 进行分层分析。第二个目标是检查18个月的医疗保健情况 干预与对照诊所服务的所有 PLwD 的利用结果，并进行二次分析 黑色 PLwD。最后，我们将通过干预诊所（N = 120）的调查来评估实施情况，然后 访谈 (N=60)，以了解黑人 PLwD 在 ACP 方面的任何差异。该项目涉及国家研究所 on Aging 的使命是改善初级保健中对 AD/ADRD 老年人的护理。这项工作将改善如何 将 ACP 方法纳入初级保健团队针对衰老相关疾病的方法中，并且可能适用于 其他门诊专业，例如肿瘤科或心脏病科。