VoiceLove: An App-Based COMmunication Tool Designed to Address DeliriUm and Improve Family ENgagement and PatIent/Family SatisfaCtion in CriticAlly Ill PaTiEnts (COMMUNICATE)

VoiceLove：一种基于应用程序的通信工具，旨在解决危重患者的谵妄问题并提高家庭参与度和患者/家属满意度（沟通）

• 批准号: 10602709
• 负责人: E Wesley ELY
• 金额: $ 50.65万
• 依托单位: VOICELOVE LLC
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10602709
• 关键词: Absence of pain sensation; Acceleration; Acute; Address; Adherence; Admission activity; Adult; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Android; Anxiety; Breathing; COVID-19; Cessation of life; Coma; Communication; Communication Tools; Complication; Control Groups; Coronary Care Units; Coronavirus; Cost Savings; Critical Illness; Delirium; Dementia; Discipline of Nursing; Dose; Drops; Electronics; Event; Exercise; Family; Family member; Feedback; Future; Goals; Health Insurance Portability and Accountability Act; Health Promotion; Hospitalization; Hospitals; Impaired cognition; Impairment; Institutionalization; Intensive Care Units; Intervention; Interview; Length of Stay; Link; Measures; Mechanical ventilation; Medical; Medical Care Team; New York; Nurses; Operative Surgical Procedures; Outcome; Pain management; Pathology; Patient Admission; Patient Care; Patients; Persons; Phase; Physicians; Pilot Projects; Policies; Presbyterian Church; Prevalence; Provider; Randomized, Controlled Trials; Recovery; Risk; Risk Reduction; Sedation procedure; Series; Small Business Technology Transfer Research; Structure; Support System; Survivors; System; Telephone; Time; Trauma; Visit; adverse outcome; care providers; dementia risk; design; direct patient care; disability; effectiveness evaluation; efficacy evaluation; empowerment; evidence base; experience; group intervention; improved; meetings; mobile application; mortality; new technology; novel; pandemic disease; pharmacologic; post-traumatic symptoms; pre-pandemic; prevent; prototype; provider communication; restraint; satisfaction; success; tool; treatment as usual; trial comparing; usability; working group

ICU delirium is a devastating complication of illness, acute trauma, and surgery often resulting in prolonged mechanical ventilation, longer lengths of stay, and long-term disability. Delirium is associated with over 12 times increased odds of developing Alzheimer’s disease (AD) and AD-related dementias (ADRD). In addition, delirium accelerates cognitive decline in AD/ADRD patients. Likewise, patients with underlying dementia are 2.5-4.7 times more likely to develop delirium. AD/ADRD patients who develop delirium have a marked increase in adverse outcomes including rate of cognitive decline, institutionalization, and death following an episode of delirium compared to those without pre-existing AD/ADRD. The ABCDEF (A2F) Bundle has the best success at decreasing ICU delirium among pharmacologic and nonpharmacologic interventions. The A2F Bundle is a group of evidence-based assessments and interventions (i.e., Assess, prevent, and manage pain, Both spontaneous awakening and breathing trials, Choice of analgesia and sedation, Delirium: assess, prevent, and manage, Early mobility and exercise, and Family engagement and empowerment) designed to improve ICU patient care regardless of illness pathology. Family engagement, an A2F bundle component independently associated with reduced ICU delirium prevalence, was implemented in 63% of ICUs pre-pandemic and dropped to under 20% during the pandemic. As the pandemic resolves, there is a gradual return to normal visitation policies, but, overall, families remain under engaged. Interventions that expand family engagement have the potential to significantly improve short- and long-term patient (e.g., AD/ADRD, disability) and family outcomes. VoiceLove LLC is developing a novel HIPAA-compliant mobile application that enables expanded family engagement by mitigating multifactorial barriers known to influence A2F bundle implementation. The VoiceLove app is a safe and time- efficient tool allowing direct communication between patients and their family members, and between care providers and absent family members, allowing more time for direct patient care. A pilot study with ICU patients at New York-Presbyterian Hospital demonstrated thousands of direct family messages exchanged without any additional nursing burden. In this Fast-Track STTR, we will refine the VoiceLove prototype and evaluate the new application among mechanically ventilated adult patients admitted to a medical, surgical, or coronary ICU. Phase I will optimize the VoiceLove app for ICU patients, families, and providers. Phase II will include a randomized control trial (RCT) comparing VoiceLove implementation to usual care control to investigate the effect on optimizing patient-family-provider communication, engagement, and ICU delirium prevalence. Mitigating ICU delirium is of paramount importance to reducing the risk of long-term complications, including an increased risk of developing AD/ADRD as well as accelerating decline in patients with AD/ADRD. This Fast-Track STTR represents a major step forward in bringing a novel technology to the bedside to expand family engagement and empowerment, decrease the prevalence of ICU delirium, and thus reduce long-term AD/ADRD risk.

ICU 谵妄是一种由疾病、急性创伤和手术引起的破坏性并发症，通常会导致长时间的昏迷。 机械通气、较长住院时间和长期残疾与超过 12 次相关。 罹患阿尔茨海默病 (AD) 和 AD 相关痴呆 (ADRD) 的几率增加。 加速AD/ADRD患者的认知能力下降，同样，患有潜在痴呆症的患者认知能力下降是其2.5-4.7倍。 发生谵妄的 AD/ADRD 患者的不良反应显着增加。 结果包括谵妄发作后的认知能力下降率、住院治疗率和死亡率 与那些没有预先存在 AD/ADRD 的程序相比，ABCDEF (A2F) 捆绑包在以下方面取得了最大的成功。 A2F 捆绑包是一组药物和非药物干预措施，可减少 ICU 谵妄。 循证评估和干预措施（即评估、预防和管理疼痛，自发性疼痛 觉醒和呼吸试验，镇痛和镇静的选择，谵妄：评估、预防和管理，早期 流动性和锻炼，以及家庭参与和赋权）旨在改善 ICU 患者护理 无论疾病病理如何，A2F 束成分都与疾病独立相关。 降低了 ICU 谵妄发生率，在大流行前已在 63% 的 ICU 中实施，后降至 20% 以下 疫情期间，随着疫情消退，探视政策逐渐恢复正常，但总体而言， 扩大家庭参与度的干预措施有可能显着提高家庭参与度。 VoiceLove LLC 致力于改善短期和长期患者（例如 AD/ADRD、残疾）和家庭结局。 开发一款符合 HIPAA 标准的新型移动应用程序，通过减轻影响来扩大家庭参与度 已知影响 A2F 捆绑实施的多因素障碍 VoiceLove 应用程序是安全且省时的。 有效的工具，允许患者与其家人以及护理人员之间直接沟通 一项针对 ICU 患者的试点研究。 纽约长老会医院展示了数以千计的直接家庭信息交换，没有任何信息 在此快速通道 STTR 中，我们将完善 VoiceLove 原型并评估新的护理负担。 在内科、外科或冠状动脉 ICU 阶段接受机械通气的成年患者中的应用。 我将为 ICU 患者、家属和提供者优化 VoiceLove 应用程序，第二阶段将包括随机测试。 对照试验 (RCT) 将 VoiceLove 实施与常规护理对照进行比较，以调查对 优化患者-家属-提供者的沟通、参与和 ICU 谵妄发生率。 谵妄对于降低长期并发症的风险至关重要，包括增加风险 发展 AD/ADRD 以及加速 AD/ADRD 患者病情恶化的快速通道 STTR。 代表着将新技术引入床边以扩大家庭参与度和 赋权，降低 ICU 谵妄发生率，从而降低长期 AD/ADRD 风险。