Integration of Geriatric Care into Dialysis Clinics

将老年护理纳入透析诊所

• 批准号: 10655156
• 负责人: Rasheeda K Hall
• 金额: $ 81.04万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10655156
• 关键词: Address; Adult; Agreement; Automobile Driving; Blinded; Caregivers; Caring; Clinic; Communities; Control Groups; Data; Development; Dialysis patients; Dialysis procedure; Elderly; Ensure; Evaluation; Feedback; Focus Groups; Future; Geriatric Assessment; Geriatrics; Goals; Guidelines; Health; Hemodialysis; Home; Human Resources; Impaired cognition; Interview; Kidney Diseases; Long-Term Care; Malnutrition; Measures; Medical; Mental Depression; Mind; Mission; Modeling; Names; Oncology; Outcome; Outpatients; Participant; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phase; Physical Function; Population; Probability; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Research; Resources; Self Administration; Social support; Source; Structure; Surveys; Syndrome; Testing; Time; Visit; Work; acceptability and feasibility; acute care; aged; cost; design; disability; effectiveness evaluation; experience; falls; health care service utilization; improved; innovation; instrument; model development; multidisciplinary; multiple chronic conditions; novel; patient engagement; personalized care; primary outcome; recruit; response; routine care; screening; standard of care; success; telehealth; treatment as usual

PROJECT SUMMARY/ABSTRACT Older dialysis patients commonly have geriatric syndromes which contribute to increased healthcare utilization and poor quality of life. Currently, identification and management of geriatric syndromes are not included in dialysis care. Adding geriatric syndrome management into routine care for dialysis patients could result in significant improvements in quality of life and healthcare utilization. Barriers to integration of geriatric evaluation and management into dialysis clinics (e.g., time, personnel, costs) can be minimized through the development of innovative geriatric care models that leverage the existing dialysis unit interprofessional team and workflow. We will pilot a new dialysis care model that includes a centralized geriatric team that uses information from the Geriatric screen for OLder Dialysis patients (GOLD) to develop individualized recommendations for geriatric syndrome management based on the patient’s priorities. The GOLD is a self-administered screening battery of validated instruments to screen for a range of geriatric syndromes (cognitive impairment, depression, falls, mobility disability, social support needs, and malnutrition). The multidisciplinary dialysis team will integrate the recommendations into their care plans with support from the centralized geriatric team. Ultimately, this geriatric care model could be seamlessly integrated into dialysis clinic structure. The objective of this application is to optimize the care model with key stakeholder input and conduct a pilot randomized controlled trial (RCT) to obtain evidence critical to inform a definitive RCT. We propose three aims: 1) iteratively refine GOLD to achieve acceptable agreement with a geriatrician evaluation, 2) iteratively refine the geriatric care model to ensure acceptability and feasibility to key stakeholders, and 3) conduct a pilot RCT (n=100) to evaluate the geriatric care model’s impact on geriatric syndrome management and inform design of a larger RCT. For Aim 1, we will have participants complete the GOLD and undergo geriatric evaluation. We will assess agreement of each GOLD instrument with its corresponding geriatric evaluation, and if target agreement is not achieved, we will iteratively modify and re-test the GOLD instrument. For Aim 2, we will refine the care model using experience-based co- design with a stakeholder advisory board and multiple phases of feedback from study participants. After patients complete the care model, these patients and their dialysis clinicians will assess acceptability and feasibility of the care model through surveys and interviews. The care model will be iteratively refined until specific metrics of success are achieved. For Aim 3, patients will be randomized to receive the geriatric care model or usual care; geriatric syndrome management measured by patient report and chart abstraction will be compared at 3 months. We will also assess patient reported outcomes, physical function, and health care utilization at intervals up to 12 months to assess their adequacy for inclusion as outcomes in a subsequent definitive RCT. Upon completion, we will have key preliminary data for a large RCT testing a novel dialysis geriatric care model. Overall, this application will address the significant problem of geriatric syndromes in the older dialysis population.

项目摘要/摘要 老年透析患者通常患有老年综合征，有助于增加医疗保健。 和生活质量差。当前，老年综合症的识别和管理不包括在 透析护理。将老年综合征管理添加到透析患者的常规护理中可能导致 生活质量和医疗保健利用的显着改善。老年评估整合的障碍 并可以通过开发最小化透析诊所（例如，时间，人员，费用）的管理 创新的老年护理模型，这些模型利用现有的透析单元跨专业团队和工作流程。 我们将试行一种新的透析护理模型，其中包括一个集中的老年小组，该团队使用了来自 老年透析患者（黄金）的老年筛查为老年筛查提供个性化建议 综合征管理基于患者的优先事项。黄金是一个自我管理的筛选电池 经过验证的仪器以筛选一系列老年综合征（认知障碍，抑郁，跌倒， 流动性残疾，社会支持需求和营养不良）。多学科透析团队将整合 在集中的老年团队的支持下，建议他们的护理计划。最终，这种老年人 可以将护理模型无缝整合到透析临床结构中。该应用的目的是 通过关键利益相关者输入优化护理模型，并进行试验随机对照试验（RCT） 获取至关重要的证据以告知确定的RCT。我们提出了三个目标：1）迭代精炼黄金以实现 与老年评估的可接受协议，2）迭代地完善老年护理模型，以确保 对主要利益相关者的可接受性和可行性，3）进行试验RCT（n = 100）以评估老年护理 模型对老年综合征管理的影响并告知更大的RCT的设计。对于AIM 1，我们将有 参与者完成黄金并接受老年评估。我们将评估每种黄金的协议 具有相应的老年评估的仪器，如果未达成目标一致，我们将迭代 修改并重新测试黄金仪器。对于AIM 2，我们将使用基于经验的共同进行改进护理模型 研究参与者的利益相关者顾问委员会和多个反馈阶段的设计。病人 完成护理模型，这些患者及其透析临床医生将评估可接受性和可行性 通过调查和访谈的护理模型。护理模型将经过迭代完善，直到特定的指标 取得了成功。对于AIM 3，将随机分配患者接受老年护理模型或通常的护理； 通过患者报告和图表抽象衡量的老年综合征管理将在3个月时进行比较。 我们还将以高达12的间隔评估患者报告的结果，身体机能和医疗保健利用 几个月来评估其在随后的确定RCT中的结果，以评估其纳入结果。完成后， 我们将拥有大型RCT测试新型透析老年护理模型的关键初步数据。总体而言，这 应用将解决老年透析人群中老年综合征的重大问题。