Telehealth-Enhanced Patient-Oriented Recovery Trajectory After Intensive Care

远程医疗增强重症监护后以患者为中心的康复轨迹

• 批准号: 10667691
• 负责人: Leanne M Boehm
• 金额: $ 82.86万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10667691
• 关键词: Acceleration; Acute respiratory failure; Address; Adult; Affect; Age; Alzheimer' s disease related dementia; Attention; Behavior; COVID-19 pandemic; Caregivers; Caring; Clinic; Clinic Visits; Clinical; Cognition; Cognitive; Cohort Studies; Complex; Control Groups; Critical Illness; Data; Dementia; Development; Employment; Evaluation; Family member; Financial Hardship; Goals; Healthcare; Home; Hospitals; Impaired cognition; Impairment; Independent Living; Institution; Intensive Care; Intensive Care Units; International; Intervention; Intervention Studies; Knowledge; Link; Long-Term Effects; Measurement; Measures; Mental Depression; Mental Health; Methods; Modeling; Monitor; Morbidity - disease rate; Outcome; Outcome Measure; Oxygen; Patients; Persons; Population; Prevalence; Process; Provider; Psyche structure; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Recovery; Reporting; Research; Resources; Risk; Sampling; Schedule; Self Management; Septic Shock; Services; Severities; Site; Social Network; Societies; Specialist; Structure; Survivors; Syndrome; Technology; Telemedicine; Testing; Time; Travel; Unemployment; Visit; Work; age stratification; blind; care delivery; clinical care; cognitive function; cognitive skill; cohort; collaborative care; comparison control; cost; design; disability; effective intervention; efficacy evaluation; efficacy study; evidence base; experience; follow-up; health care service utilization; hospital readmission; improved; indexing; patient oriented; peer; physical conditioning; primary outcome; programs; recovery services; retiree; rural area; secondary outcome; sepsis induced ARDS; social; social integration; socioeconomics; standard of care; survivorship; telehealth; trial comparing; uptake

Approximately 33-50% of intensive care unit (ICU) survivors develop long-term cognitive impairment – a well-established form of Alzheimer’s Disease Related Dementia (ADRD). ICU-acquired ADRD prevalence is especially high in acute respiratory distress syndrome and sepsis survivors, affecting up to 80%. This loss of cognition leads to loss of independence, employment, and quality of life and persists for months to years. ICU-acquired ADRD is part of a broader syndrome known as Post-Intensive Care Syndrome (PICS), including physical, mental, and socioeconomic impairments. ICU Recovery Clinics (ICU-RC) are a feasible and promising intervention to collaboratively address ICU-acquired ADRD and other PICS impairments, but in-person access is limited. There is a need to study efficacy of ICU-RCs with large cohorts using alternative delivery strategies to expand availability and reach. Older (age >=45) septic shock and/or acute respiratory failure patients are at a combined risk for ICU-acquired ADRD among other impairments, and the ideal population to first address this knowledge gap. The Vanderbilt ICU Recovery Center team has nearly 10 years of experience providing interdisciplinary, collaborative care to identify and treat ICU-acquired ADRD and other PICS impairments experienced by ICU survivors. We hypothesize that a collaborative telemedicine-delivered interdisciplinary ICU-RC intervention effectively identifies and improves long-term cognitive function, and as secondary outcomes, physical and mental health function, social integration, and self-management behaviors vs. a control condition with follow-up chosen by the discharge team. Therefore, in a sample of older septic shock and acute respiratory failure survivors, we aim to examine the efficacy of telemedicine ICU-RC services vs. control follow-up chosen by the discharge team in identifying and managing ICU-acquired ADRD and other PICS impairments (i.e., physical, mental health, social, self-management function) at 6 months after hospital discharge. We will address our hypothesis and aims by conducting a controlled trial of 202 patients randomized 1:1 with age stratification to telemedicine ICU-RC or control (101 per group). Telemedicine recipients will receive a minimum of 2 ICU-RC visits within 3 months of hospital discharge or return to home if discharged to another institution, with additional follow-up determined by the severity of PICS impairment. Our primary outcome is cognitive function (Aim 1) at 6 months using the MoCA-Blind and PROMIS Cognitive Function from the Long-term Core Outcome Measurement Set for ICU survivors. Our secondary outcomes are physical and mental health functioning (Aim 2) and social integration and self-management behaviors (Aim 3). In addition to 6-month measurements, we will assess pre-hospital function and 1-week post-discharge to assess discharge functional trajectories. This research will provide scientific justification for the continued development, implementation, and scaling of ICU recovery programs. Ultimately, such knowledge can improve the quality of life for millions of ICU survivors and family members by reducing ADRD burden.

大约 33-50% 的重症监护病房 (ICU) 幸存者会出现长期认知障碍，这是一种公认​​的阿尔茨海默病相关痴呆 (ADRD)，在急性呼吸窘迫综合征和急性呼吸窘迫综合征中，ICU 获得性 ADRD 的患病率尤其高。败血症幸存者中，这种认知丧失会导致独立性、就业和生活质量的丧失，并持续数月至数年，是一种更广泛的综合症的一部分，称为 ADRD。重症监护后综合症 (PICS)，包括身体、精神和社会经济障碍，ICU 康复诊所 (ICU-RC) 是一种可行且有前景的干预措施，可协作解决 ICU 获得性 ADRD 和其他 PICS 障碍，但需要亲自前往。需要使用替代递送策略来研究 ICU-RC 的疗效，以扩大老年（年龄 >= 45 岁）脓毒性休克和/或急性呼吸衰竭患者的综合风险。范德比尔特 ICU 恢复中心团队拥有近 10 年的跨学科协作护理经验，可识别和治疗 ICU 获得性 ADRD 及其他 PICS 障碍。我们追求通过协作式远程医疗提供的跨学科 ICU-RC 干预措施有效地识别和改善长期认知功能，并作为次要结果：身心健康功能、社会融合和因此，在老年感染性休克和急性呼吸衰竭幸存者的样本中，我们的目的是检查远程医疗 ICU-RC 服务与控制随访的效果。出院团队在出院后 6 个月时选择的用于识别 ICU 获得性 ADRD 和其他 PICS 障碍（即身体、心理健康、社交、自我管理功能）的方案我们将提出我们的管理假设和目标。通过对 202 名患者进行对照试验，按年龄分层随机分配至远程医疗 ICU-RC 或对照组（每组 101 名），远程医疗接受者将在出院或回家后 3 个月内接受至少 2 次 ICU-RC 就诊。如果出院到另一个机构，则根据 PICS 损伤的严重程度确定额外的随访，我们的主要结果是使用 MoCA-Blind 和 PROMIS 在 6 个月时的认知功能（目标 1）。 ICU 幸存者长期核心结果测量集的认知功能 除了 6 个月的测量外，我们的次要结果是身心健康功能（目标 2）以及社会融合和自我管理行为。将评估入院前的功能和出院后 1 周的功能轨迹，这项研究将为 ICU 康复计划的持续开发、实施和扩展提供科学依据，最终，这些知识可以改善患者的生活质量。通过减轻 ADRD 负担，帮助数百万 ICU 幸存者及其家人。