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（由申请人提供）：评估家庭基地初级保健（HBPC）对Homeboun D老年人的结果的影响，包括住院和急诊科（ED）访问，生活质量和症状控制，费用，费用在美国的护理和对非正式护理人员的照料负担。大量的医疗保健支出模式的医疗保健指定模式已经研究了，但是观察表明，HBPC可以改善预后，并减少这些弱势群体的患者，我们提出了3个特定目标：比较HBPC和HBPC和HBPC和HBPC的影响。 OBPC 1）关于Hosspital和ED访问率，症状控制和生活质量以及对家庭的满意度；与OBPC患者相比，我们将招募350名基于社区的成年人。此后，用于确定医疗保健利用的实用临床概念和卫生政策应用程序。老年人的家人。包括对慢性解决和医疗之家概念的多学科管理。