Nursing Home Prevention of Injury in Dementia (NH PRIDE)

疗养院预防痴呆症伤害 (NH PRIDE)

• 批准号: 10092886
• 负责人: Sarah Dyer Berry
• 金额: $ 47.59万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092886
• 关键词: Accounting; Address; Adherence; Administrator; Alzheimer' s disease related dementia; Area; Behavior; Caring; Cessation of life; Charge; Clinical; Communication; Communities; Community Healthcare; Complex; Consequentialism; Data; Data Set; Dementia; Dose; Drug Prescriptions; Drug usage; Education; Effectiveness; Elderly; Elements; Emergency department visit; Ensure; Failure; Fall prevention; Family; Fracture; Future; Goals; Healthcare Systems; Hospitalization; Hyperglycemia; Hypertension; Injury; Intervention; Intervention Trial; Knowledge; Manuals; Measures; Medical; Modeling; Modification; Monitor; Nurses; Nursing Homes; Nursing Services; Osteoporosis; Outcome; Outcome Measure; Pain management; Persons; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Pragmatic clinical trial; Prevention program; Prevention strategy; Process Measure; Protocols documentation; Provider; Public Health; Recommendation; Research; Resources; Risk; Risk Estimate; Risk Factors; Safety; Scientist; Service delivery model; Services; Standardization; Syndrome; System; Testing; Time; Training; Videoconferencing; Visit; base; cardiometabolism; care coordination; care delivery; care outcomes; care systems; case finding; cost; cost effective; design; effectiveness evaluation; efficacy testing; efficacy trial; experience; fall injury; falls; fracture risk; functional decline; functional status; high risk; implementation barriers; implementation measures; implementation science; implementation study; improved; injury prevention; model design; modifiable risk; nonalzheimer dementia; osteoporosis with pathological fracture; post intervention; pragmatic trial; predictive modeling; prevent; prevention service; primary outcome; randomized trial; remote location; service intervention; severe injury; success; therapy design

Abstract: Injurious falls are common, morbid, and costly for nursing home (NH) residents, particularly those with Alzheimer’s Disease and Related Dementias (ADRD). Our long-term goal is to reduce injurious falls in NH residents. The current proposal will develop an Injury Liason Service (ILS) intervention designed to promote deprescribing of psychoactive and cardiometabolic drugs AND encourage osteoporosis treatment. The intervention will address common barriers to fall prevention encountered in NH studies including fragmented communication. The following specific aims are proposed: 1) Develop an ILS care model designed to prevent injurious falls in NH residents using a) an automated risk calculator to identify high risk residents, b) centralized care coordination by an Injury Liaison Nurse, and c) videoconferencing with NH staff; 2) Test the ILS’ implementation-effectiveness in four NH facilities in residents with and without ADRD; and 3) Develop the protocol and resources for a phase 2 efficacy trial of the ILS model in 2-3 NH chains. The central hypothesis is that the ILS model will reduce injurious falls by changing care delivery through deprescribing and increased osteoporosis treatment. We hypothesize that implementation barriers are greater for residents with ADRD, and that it will require iterative intervention modifications to achieve adherence in this population. We will use experience-based co-design principles in Aim 1 to convene key stakeholders to transform the components of the intervention into a single, pragmatic care model that could be disseminated across NH systems. In Aim 2, we will implement the care model in four NH facilities. This will require programming the prediction model within the EMRs to identify high risk residents. A centralized ILS nurse will enact deprescribing recommendations and osteoporosis treatment among high risk residents (n~80) from a remote location. Videoconferencing will be used to facilitate education and communication. We will measure implementation success using post intervention measures of acceptability, demand, fidelity, and practicality. Effectiveness will be measured using process measures (e.g., medication dose reduction) using a pre-post design, and safety will be assessed using both pre-post measures from the Minimum Data Set (MDS) and chart review, stratified by ADRD status. In addition, we will validate the planned primary outcome for a future pragmatic trial, injurious falls ascertained from the MDS, with chart review. In Aim 3, we will develop the protocol and all materials needed for conducting an embedded pragmatic clinical trial of the ILS within 2-3 NH chains. The research team has considerable experience with NH research, including implementation science. At the completion of this study, we will have developed a robust care model that can be readily deployed by NH systems and evaluated for its impact on injurious falls in ADRD residents. We will be ideally positioned to conduct a pragmatic clinical trial embedded in NH systems to test the efficacy of the ILS. In addition to addressing injurious falls, this model has the potential to be modified for other complex geriatric syndromes in NH residents with ADRD.

抽象的： 对于护士住宅（NH）居民，尤其是那些有伤害的瀑布很常见，病态且昂贵，尤其是那些 阿尔茨海默氏病和相关痴呆症（ADRD）。我们的长期目标是减少NH中有害的跌倒 居民。当前的提案将开发旨在促进的伤害利亚森服务（ILS）干预措施 对精神活性和心脏代谢药物的排除，并鼓励骨质疏松症治疗。这 干预将解决NH研究中遇到的预防跌倒的常见障碍 沟通。提出了以下具体目的：1）开发旨在防止的ILS护理模型 NH居民使用A）自动化风险计算器来识别高风险居民的伤害性跌倒，b）集中 受伤联络护士的护理协调，c）与NH员工进行视频会议； 2）测试ILS 有或没有ADRD的居民的四个NH设施中的实施效应； 3）发展 2-3 NH链中ILS模型的2阶段有效试验的协议和资源。中心假设是 ILS模型将通过不分割和增加来减少护理交付来减少伤害性跌倒 骨质疏松治疗。我们假设ADRD居民的实施障碍更大，并且 它将需要迭代干预修改才能在该人群中遵守。我们将使用 AIM 1中基于经验的共同设计原则，以方便关键利益相关者改变组成部分 干预可以在NH系统中传播的单一务实护理模型。在AIM 2中， 我们将在四个NH设施中实施护理模型。这将需要编程预测模型 在EMR中识别高风险居民。集中的ILS护士将进行分类 偏远位置的高风险居民（n〜80）的建议和骨质疏松治疗。 视频会议将用于促进教育和沟通。我们将衡量实施 使用后干预后的可接受性，需求，忠诚和实用性的成功措施。有效性将会 使用过程测量（例如，减少药物剂量降低）可以使用前设计和安全进行测量 将使用最小数据集（MD）和图表审查的两项前措施进行评估 通过ADRD状态。此外，我们还将验证计划的主要结果，以进行未来的务实试验，受伤 瀑布从MDS中确定，以及图表审查。在AIM 3中，我们将制定协议和所有材料 在2-3 NH链中进行ILS的嵌入式务实临床试验所需。研究团队 已经考虑了NH研究的经验，包括实施科学。完成此过程 研究，我们将开发出一种可靠的NH系统并评估的强大护理模型 因为它对阿德德居民受伤的跌倒的影响。我们将在理想情况下进行务实的临床 试验嵌入了NH系统中以测试IL的效率。除了解决有害瀑布之外， 模型有可能修改ADRD的NH居民中其他复杂的老年综合症。

项目成果

Improving shared decision-making for osteoporosis pharmacologic therapy in nursing homes: a qualitative analysis.

• DOI: 10.1007/s11657-021-01050-0
• 发表时间: 2022-01-03
• 期刊: ARCHIVES OF OSTEOPOROSIS
• 影响因子: 3
• 作者: Colon-Emeric, Cathleen S.;Hecker, Emily J.;McConnell, Eleanor;Herndon, Laurie;Little, Milta;Xue, Tingzhong;Berry, Sarah
• 通讯作者: Berry, Sarah