A Nursing Home Pragmatic Clinical Trial of APPROACHES (Aligning Patient Preferences: a Role Offering Alzheimer's patient, Caregivers, and Healthcare providers Education and Support)

疗养院实用方法临床试验（调整患者偏好：为阿尔茨海默病患者、护理人员和医疗保健提供者提供教育和支持的角色）

• 批准号: 10018605
• 负责人: SUSAN E HICKMAN
• 金额: $ 95.1万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10018605
• 关键词: Admission activity; Advance Care Planning; Alzheimer' s disease diagnosis; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Caregivers; Caring; Cessation of life; Clinical; Cognitive; Data; Data Analyses; Data Set; Data Sources; Decision Making; Dementia; Diagnosis; Do Not Resuscitate Order; Documentation; Education; Electronic Health Record; Emergency department visit; Enrollment; Ensure; Enteral Feeding; Ethics; Family; Family Caregiver; Foundations; Goals; Health; Health Personnel; Health system; Healthcare; Hospitalization; Hospitals; Indiana; Infrastructure; Intervention; Lead; Life; Measures; Medical; Medicare claim; Modeling; Nursing Homes; Outcome; Outcome Measure; Outcome Study; Patient Care; Patient Preferences; Patients; Persons; Phase; Physicians; Pragmatic clinical trial; Procedures; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Regulation; Research; Role; Rural; Social Workers; Specialist; Standardization; Surveys; Testing; Training; Translations; United States Centers for Medicare and Medicaid Services; Work; aggressive therapy; arm; base; cohort; cost; data management; end of life; experience; hospice environment; hospitalization rates; improved; member; multi-component intervention; nursing intervention; operation; organizational structure; pragmatic trial; preference; primary outcome; programs; satisfaction; secondary outcome; treatment arm

PROJECT SUMMARY A significant number of patients Alzheimer's disease or related dementia diagnoses will be cared for in nursing homes near the end of life. Unfortunately, many of these patients experience unwanted and burdensome medical treatments, such as potentially avoidable hospitalizations, that negatively impact quality of life. Advance care planning (ACP) discussions with patients and family caregivers are important to explore goals in advance of a crisis and support informed, values-based decision-making. The ACP process helps ensure that preferences about treatments such as hospitalization are known, documented, and honored. Research indicates that ACP can reduce burdensome treatments and increase the likelihood that care will match documented preferences. Nursing homes are currently required by regulations to offer ACP to patients and families. However, there are no training requirements for nursing home staff and approaches to fulfilling this regulatory and ethical responsibility vary widely, resulting in inconsistent ACP. The “Aligning Patient Preferences – a Role Offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES)” trial will test the ACP Specialist Program. Existing nursing home staff members will be trained to enhance care and reduce unwanted, burdensome hospitalizations through improved ACP procedures, standardized staff education on ACP, and systematic ACP facilitation. The primary trial outcome is hospital transfers (admissions and emergency department visits) per 1000 person-days alive. Consistent with the spirit of a pragmatic trial, study outcomes rely on data already collected for quality improvement, clinical or billing purposes. In the 18 month R21 pilot phase, the aims are to: 1) Establish the trial's organizational structure and processes; and 2) Pilot test the intervention in 4 nursing homes. In the R33 phase, a pragmatic cluster randomized clinical trial will be conducted in partnership with 3 nursing home corporations who operate a combined total of 206 diverse urban and rural facilities in 14 states. The aims of the 42 month R33 phase are to: 3) Evaluate the primary outcome of hospital transfers over 12 months among patients with dementia in intervention versus control nursing homes; and 4) Compare ACP documentation, measures of quality of care at the end of life, and patient and family satisfaction between the intervention versus control nursing homes. If successful, the ACP Specialist Program will be primed for rapid translation into nursing home practice to reduce unwanted, burdensome hospitalizations and improve quality of care for patients with dementia.

项目摘要 在护士中，将有大量患者的阿尔茨海默氏病或​​相关痴呆诊断的患者 生活在生命尽头的房屋。不幸的是，其中许多患者经历了不必要的和抛光 医疗治疗，例如可能避免的住院治疗，会对生活质量产生负面影响。 与患者和家庭护理人员的预先护理计划（ACP）讨论对于探索目标很重要 危机前进，并支持知情的，基于价值的决策。 ACP过程有助于确保 已知，记录和尊敬对住院等治疗的偏好。研究 表明ACP可以减少易燃的治疗，并增加护理匹配的可能性 记录的首选项。目前，法规要求疗养院向患者提供ACP和 家庭。但是，没有针对护士家庭工作人员的培训要求，也没有实现这一目标的方法 监管和道德责任差异很大，导致ACP不一致。 “对齐患者 偏好 - 为阿尔茨海默氏症患者，看护人和医疗保健提供者教育提供的角色以及 支持（方法）”试验将测试ACP专家计划。现有护士家庭工作人员将 接受培训以通过改善ACP来增强护理和减少不必要的住院治疗 程序，ACP的标准化员工教育以及系统的ACP设施。主要试验结果是 每1000人日还活着的医院转学（招生和急诊务访问）。与 务实试验的精神，研究成果依赖于已经收集的数据来改进质量，临床或 计费目的。在18个月R21飞行员阶段，目的是：1）建立审判的组织 结构和过程； 2）试点测试4个护士房屋的干预措施。在R33阶段，务实 群集随机临床试验将与3个经营的护士家庭合作进行 14个州共有206个潜水员城市和农村设施。 42个月R33阶段的目的是 至：3）评估痴呆症患者12个月以上医院转移的主要结果 干预与控制护士房屋； 4）比较ACP文档，护理质量的度量 在生命的尽头，干预与对照护士房屋之间的患者和家庭满意度。如果 成功的ACP专家计划将被启示，以快速转化为护士家庭诊所 减少不必要的住院治疗，并改善痴呆症患者的护理质量。