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.

项目概要/摘要 老年透析患者通常患有老年综合症，这有助于增加医疗保健利用率 目前，老年综合症的识别和管理并未包括在内。 将老年综合征管理纳入透析患者的常规护理可能会导致 生活质量和医疗保健利用的显着改善 整合老年病学评估的障碍。 通过开发可以最大限度地减少透析诊所的管理和管理（例如时间、人员、成本） 利用现有透析单位跨专业团队和工作流程的创新老年护理模式。 我们将试行一种新的透析护理模式，其中包括一个集中的老年病学团队，该团队使用来自 针对老年透析患者的老年筛查 (GOLD)，为老年患者制定个性化建议 GOLD 是基于患者优先事项的综合征管理。 经过验证的仪器可筛查一系列老年综合症（认知障碍、抑郁、跌倒、 行动障碍、社会支持需求和营养不良）。 最终，在集中老年病学团队的支持下，将建议纳入他们的护理计划。 护理模型可以无缝集成到透析诊所结构中。该应用程序的目的是 根据关键利益相关者的意见优化护理模式，并进行试点随机对照试验 (RCT) 获得对于确定性 RCT 至关重要的证据，我们提出三个目标：1）迭代完善 GOLD 以实现。 与老年科医生评估达成可接受的协议，2) 迭代完善老年护理模型以确保 主要利益相关者的可接受性和可行性，以及 3) 进行试点随机对照试验 (n=100) 来评估老年护理 模型对老年综合征管理的影响并为更大的 RCT 设计提供信息 对于目标 1，我们将有。 参与者完成 GOLD 并接受老年评估。我们将评估每个 GOLD 的一致性。 仪器及其相应的老年评估，如果没有达到目标协议，我们将迭代 对于目标 2，我们将使用基于经验的合作来完善护理模型。 与利益相关者顾问委员会和研究参与者的多个阶段的反馈进行设计。 完成护理模式后，这些患者及其透析爱好者将评估以下方案的可接受性和可行性 通过调查和访谈对护理模型进行迭代完善，直到达到具体指标为止。 对于目标 3，患者将被随机分配接受老年护理模式或常规护理； 通过患者报告和图表摘要衡量的老年综合症管理将在 3 个月时进行比较。 我们还将评估患者报告的结果、身体功能和医疗保健利用率，间隔最多 12 几个月来评估其是否足以作为后续最终随机对照试验的结果。 我们将获得用于测试新型透析老年护理模型的大型随机对照试验的关键初步数据。 该应用将解决老年透析人群中老年综合症的重大问题。