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 del妄是疾病，急性创伤和手术的毁灭性并发症，通常会导致长时间 机械通气，更长的住院时间和长期残疾。 del妄与12次超过12次有关 发展阿尔茨海默氏病（AD）和与AD相关的痴呆症（ADRD）的几率增加。另外，del妄 AD/ADRD患者的认知能力下降加速。同样，潜在痴呆症患者为2.5-4.7倍 更有可能发展ir妄。发展妄想的广告/ADRD患者广告明显增加 结局，包括认知能力下降的速度，制度化和死亡，del妄之后 与没有预先存在的AD/ADRD的人相比。 ABCDEF（A2F）捆绑包在 在药理学和非药物干预措施中减少ICU del妄。 A2F捆绑包是一个组 基于证据的评估和干预措施（即评估，预防和管理疼痛，这两个赞助商 觉醒和呼吸试验，镇痛和镇静的选择，ir妄：评估，预防和管理，早期 流动性和锻炼以及家庭参与和授权）旨在改善ICU患者护理 不论疾病病理学。家庭参与，与与之独立相关的A2F捆绑组件 ICU ir妄患病率降低，在63％ 在大流行期间。随着大流行的解决，正常探视政策的年级回报，但总体而言 家庭仍在订婚。扩大家庭参与的干预措施有可能显着 改善短期和长期患者（例如AD/ADRD，残疾）和家庭结局。 Voicelove LLC是 开发一种新颖的符合HIPAA的移动应用程序，该应用程序可以通过缓解来扩大家庭参与度 已知会影响A2F捆绑实现的多因素障碍。 Voicelove应用程序是一个安全的时间 - 有效的工具，允许患者与家人之间以及护理之间直接沟通 提供者和缺席家庭成员，为直接患者护理提供更多时间。与ICU患者的试点研究 在纽约长老会医院展示了成千上万的直接家庭消息，没有任何 额外的护士伯恩。在这个快速轨道的sttr中，我们将完善语音原型并评估新的原型 在接受医学，外科或冠状动脉ICU的机械通风的成年患者中应用。阶段 我将为ICU患者，家庭和提供者优化Voicelove应用程序。第二阶段将包括一个随机 对照试验（RCT）将语音实施与通常的护理控制进行比较，以调查对 优化患者提供的家庭杂货，参与度和ICU ir妄患病率。减轻ICU ir妄对降低长期并发症的风险至关重要，包括增加风险 开发AD/ADRD以及AD/ADRD患者的下降。这个快速轨道sttr 是将新型技术带到床边以扩大家庭参与度和 授权，降低ICU del妄的患病率，从而降低长期AD/ADRD风险。