Transforming residential palliative care for persons with dementia through behavioral economics and data science

通过行为经济学和数据科学改变痴呆症患者的住院姑息治疗

• 批准号: 10017845
• 负责人: Scott D Halpern
• 金额: $ 75.9万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10017845
• 关键词: Address; Admission activity; Advance Care Planning; American; Area; Arts; Assisted Living Facilities; Behavior; Behavior Therapy; Behavioral; Benchmarking; Businesses; Caregivers; Caring; Collaborations; Communication; Computers; Conflict (Psychology); Data; Data Science; Dementia; Discipline of Nursing; Disease; Electronic Health Record; Engineering; Faculty; Family; Family Caregiver; Family Nursing; Fostering; Funding; Future; Goals; Grant; Health Policy; Healthcare; Hospitalization; Hospitals; Institution; Intervention; Intervention Studies; Knowledge; Lead; Life; Link; Logistics; Machine Learning; Measures; Mechanical ventilation; Mentors; Methodology; Methods; Modeling; Monitor; Natural Language Processing; Nurses; Nursing Homes; Online Systems; Outcome; Outpatients; Palliative Care; Pathway Analysis; Patient Preferences; Patients; Pennsylvania; Persons; Physicians; Pilot Projects; Positioning Attribute; Pragmatic clinical trial; Process; Qualitative Methods; Research; Research Personnel; Research Support; Resources; Risk; Schools; Science; Scientist; Services; Site; Social Network; Societies; Specialist; Surveys; System; Testing; Translating; United States National Institutes of Health; Universities; Variant; Work; advanced disease; base; behavior change; behavioral economics; care delivery; care outcomes; care systems; caregiver interventions; cost; dementia care; effective intervention; effectiveness trial; efficacy study; electronic data; end of life; health economics; hospice environment; implementation science; improved; innovation; insight; medical schools; novel; palliative; peer; person centered; pragmatic trial; social; statistics; success; symptom management; therapy development; tool

The central goal of this proposed Roybal Center is to develop, test, and implement novel interventions that bridge the dramatic gap between the supply of and need for palliative care services among persons with dementia (PWD) living in long-term services and support (LTSS) facilities, as well as their family caregivers. Several innovative aspects of this proposed Center position us to succeed in this challenging but increasingly important space. First, we have assembled a team comprising more 50 investigators and staff from 5 schools within the University of Pennsylvania, and the most accomplished investigators of palliative approaches to care for PWD from 11 peer institutions. These investigators possess content knowledge and tremendous expertise in leading all Stages of behavioral intervention development as defined by the NIH Stage Model. Second, we will support these behavioral scientists by linking them with Center faculty with expertise in several key methodologic areas including behavioral economics, data science, statistics, qualitative methods, health policy and economics, and implementation science. Our focus on translating behavioral economic insights to change the behaviors of clinicians and caregivers involved in the care of PWD builds on our recent success using similar approaches to improve palliative care delivery in outpatient and hospital settings. Our focus on using machine learning, natural language processing, and network methods will enable us to (a) identify mechanisms of clinician behavior that account for aggressive care for PWD, (b) identify PWD with the greatest unmet palliative care needs so as to sustainably target intervention delivery, and (c) more efficiently measure person-centered outcomes in the context of large, pragmatic trials of the most promising interventions. Third, this Center is being launched in partnership with Genesis HealthCare, the nation's largest owner of LTSS facilities, with 401 nursing homes and assisted living facilities across the U.S. These facilities provide ideal settings within which to develop and test interventions that will be effective and sustainable in the real world. Further, by developing and testing the interventions in these settings, while continually increasing our collaborations with other owners of LTSS facilities, we will be ideally positioned to implement effective interventions in the places in which the majority of Americans with dementia are cared for near the end of life. This Center will be directed by a Steering Committee, and will include a Management and Administrative Core housed within Penn's existing Palliative and Advanced Illness Research (PAIR) Center. A Pilot Core will select, guide, and monitor pilot projects chosen for funding each year. We propose two pilots for funding in the first year: a Stage I study that seeks to adapt a web-based advance care planning platform for use among PWD and their caregivers in LTSS settings, and a Stage 0 study that will use data science methods to identify clinician behaviors associated with hospitalization risk among PWD, yielding targets for future interventions.

这个拟议的皇家中心的核心目标是开发，测试和实施新颖的干预措施 弥合了与 痴呆症（PWD）居住在长期服务和支持（LTSS）设施及其家庭护理人员中。 这个提议的中心地位的几个创新方面我们在这一挑战但越来越多的方面取得了成功 重要空间。首先，我们组建了一个团队，包括50名来自5所学校的调查员和员工 在宾夕法尼亚大学，以及最有成就的姑息治疗方法的调查员 对于来自11个同行机构的PWD。这些研究人员拥有内容知识和巨大的专业知识 在领导行为干预发展的所有阶段，NIH阶段模型定义。 其次，我们将通过将这些行为科学家与中心教师联系起来，以支持这些行为科学家的专业知识 关键方法论领域，包括行为经济学，数据科学，统计，定性方法，健康 政策和经济学以及实施科学。我们专注于将行为经济见解转化为 改变参与PWD护理的临床医生和护理人员的行为，以我们最近的成功为基础 使用类似的方法来改善门诊和医院环境中的姑息治疗。我们专注于 使用机器学习，自然语言处理和网络方法将使我们能够（a）确定 解释PWD积极护理的临床医生行为的机制，（b）识别PWD最大的PWD 未满足的姑息治疗需求，以可持续针对干预措施，（c）更有效地衡量 在最有希望的干预措施的大型，务实的试验中，以人为中心的结果。 第三，该中心正在与Genesis Healthcare合作开设 LTSS设施，在美国设有401家疗养院和辅助生活设施 理想的环境开发和测试干预措施，这些干预措施将有效和可持续 世界。此外，通过制定和测试这些设置中的干预措施，同时不断增加我们的 与其他LTSS设施的其他所有者合作，我们将处于实施有效的理想位置 大多数痴呆症的美国人在生命的尽头都受到照顾的地方的干预措施。 该中心将由指导委员会指导，并将包括管理和行政核心 位于宾夕法尼亚州现有的姑息和晚期疾病研究（PAIP）中心。飞行员核心将选择， 指南并监视每年选择用于资金的飞行员项目。我们提出了两名飞行员在第一次资金 年：我的研究阶段，旨在调整基于网络的高级护理计划平台以在PWD中使用 及其在LTSS设置中 PWD中与住院风险相关的临床医生行为，为将来的干预措施带来了目标。