Home-based Primary Care for Homebound Seniors: a Randomized Controlled Trial

居家老年人的家庭初级护理：随机对照试验

• 批准号: 9082810
• 负责人: Alex D Federman
• 金额: $ 72.15万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9082810
• 关键词: Accident and Emergency department; Administrator; Adopted; Adoption; Adult; Age; Ambulatory Care; American; Care given by nurses; Caregiver Burden; Caregivers; Caring; Chronic; Chronic Disease; Clinical; Communities; Cost Control; Data; Devices; Effectiveness; Elderly; Emergency department visit; Evaluation; Exclusion; Expenditure; Family; Family member; Fostering; Friends; Future; Health; Health Care Costs; Health Care Research; Health Policy; Health Services Research; Healthcare; Healthcare Systems; Home environment; Hospitalization; House Call; Individual; Institute of Medicine (U.S.); Insurance Carriers; Insurance Claim Review; Intervention; Interview; Knowledge; Left; Medical; Medicare; Medicare/Medicaid; Mental Depression; Methods; Modeling; New York City; Nursing Economics; Observational Study; Outcome; Outpatients; Pain; Patient Care; Patients; Physicians; Policies; Primary Health Care; Process; Prospective Studies; Provider; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Research; Science; Scientific Advances and Accomplishments; Services; Site; Symptoms; Translating; Translations; United States Centers for Medicare and Medicaid Services; Visit; age related; arm; base; care burden; care giving burden; caregiving; chronic care model; cost; design; disorder control; experience; flexibility; health care delivery; health care quality; health care service utilization; health economics; improved outcome; informal caregiver; inner city; innovation; interest; medical attention; meetings; multidisciplinary; older patient; pragmatic trial; prevent; programs; public health relevance; randomized trial; satisfaction; trial design

 DESCRIPTION (provided by applicant): The objective of this study is to evaluate the impact of home-based primary care (HBPC) on outcomes for homebound older adults, including hospitalization and emergency department (ED) visits, quality of life and symptom control, costs of care, and burden of care for their informal caregivers. We will also conduct a mixed methods dissemination and implementation evaluation of HBPC. Over one million seniors in the U.S. have functional limitations that prevent them from receiving office-based primary care (OBPC). As a result, homebound adults typically experience poor disease control, high rates of hospitalization, and large healthcare expenditures resulting for hospitalizations and ED use. Few modes of healthcare delivery designed specifically for the homebound have been studied, but observational data suggest that HBPC could improve outcomes and reduce spending for these highly vulnerable patients. We propose a pragmatic randomized controlled trial of HBPC vs. OBPC for homebound older adults, with 3 Specific Aims: to compare the impact of HBPC and OBPC 1) on hospitalization and ED visit rates, symptom control and quality of life, and satisfaction with care among homebound elders; 2) on caregiving burden among informal caregivers (e.g., family and friends); and 3) on healthcare expenditures for the homebound. We hypothesize that patients in HBPC and their caregivers will have better outcomes compared to OBPC patients. We will recruit 350 homebound adults ≥ 65 years in New York City from outpatient clinical and community- based settings. HBPC will be delivered through Mount Sinai Visiting Doctors or the Chelsea Village House Calls Program. Patients randomized to OBPC will continue to receive care from their usual outpatient primary care provider or will be assigned one within the Mount Sinai healthcare system. We will conduct interviews in English and Spanish at baseline and quarterly thereafter up to 1 year. Medicare and Medicaid claims data will be used to determine healthcare utilization and costs. The study embraces the concepts of a pragmatic trial design to facilitate the translation of study findings for practical clinical, systms, and health policy applications. The study team includes experts in aging related health services research, health economics, health policy, randomized clinical trials, and the medical and nursing care of homebound older adults. The proposed study would be the largest prospective study of homebound older adults and the only randomized trial of HBPC for the homebound. It would fill important knowledge gaps in our understanding of the effects of HBPC for the homebound. The study is consistent with the Institute of Medicine's call for expanded research on comprehensive models of chronic care, including the multidisciplinary management of chronic diseases and the medical home concept.

 描述（由适用提供）：这项研究的目的是评估家庭基于家庭的初级保健（HBPC）对家庭居住老年人结果的影响，包括住院和急诊科（ED）就诊，生活质量和症状控制，护理费用以及护理成本以及护理烧伤的非正式护理人员。我们还将对HBPC进行混合方法传播和实施评估。在美国，超过一百万的老年人有功能限制，可以阻止他们获得基于办公室的初级保健（OBPC）。结果，家里的成年人通常会经历疾病控制不佳，住院率高以及导致住院和ED使用的大量医疗支出。很少有专门为家居设计的医疗保健提供模式已经研究了，但是观察数据表明，HBPC可以改善预后，并减少这些高度脆弱的患者的支出。我们提出了HBPC与OBPC的务实的随机对照试验对家人的老年人，具有3个具体目标：比较HBPC和OBPC的影响1）1）对住院和ED的访问率，往来率和咨询率，同时的控制率，控制率和满意度，以及在老年人中对住所的满意度； 2）关于非正式护理人员（例如家人和朋友）的护理烧伤； 3）关于家里的医疗支出。我们假设与OBPC患者相比，HBPC及其护理人员的患者的结果将更好。我们将从门诊临床和基于社区的环境中招募纽约市350名≥65岁的成年人。 HBPC将通过西奈山来访医生或切尔西乡村的电话计划来交付。随机分配给OBPC的患者将继续从通常的门诊初级保健提供者那里获得护理，或者将在西奈山医疗保健系统中分配。我们将在基线上进行英语和西班牙语的采访，此后季度最多1年。 Medicare和Medicaid索赔数据将用于确定医疗保健利用和成本。该研究涵盖了务实的试验设计的概念，以促进对实用临床，系统和卫生政策应用的研究结果的翻译。研究团队包括老龄化相关卫生服务研究，卫生经济学，卫生政策，随机临床试验的专家，以及家庭陪伴老年人的医疗和护理护理。拟议的研究将是最大的对家庭居民的前瞻性研究，也是HBPC唯一的随机试验。这将填补我们对HBPC对居家影响的影响的重要知识差距。这项研究与医学研究所呼吁扩大慢性护理模型的研究相一致，包括慢性疾病的多学科管理和医疗之家的概念。