Improving Primary Care Clinicians' Advance Care Planning for Alzheimer's Disease and Related Dementias

改善初级保健临床医生针对阿尔茨海默病和相关痴呆症的预先护理计划

基本信息

批准号：
10738376
负责人：
Christine E Kistler
金额：
$ 79.6万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-30 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10738376
关键词：
Address Adoption Advance Care Planning Affect Aging Algorithms Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Cardiology Caregivers Caring Cessation of life Characteristics Clinic Clinical Trials Communication Consolidated Framework for Implementation Research Control Groups Data Dementia Diagnosis Education Elderly Emergency department visit Ensure Ethnic Origin Evaluation Exclusion Family Feedback Future Goals Healthcare Healthcare Systems Hospitalization Hour Integrated Health Care Systems Intervention Interview Length of Stay Life Location Measures Medical Medical Care Team Medicare Methods Mission Modeling National Institute on Aging Nurses Nursing Homes Oncology Outcome Outcome Assessment Outcome Measure Outpatients Palliative Care Patients Persons Physicians Populations at Risk Positioning Attribute Primary Care Process Progressive Disease Provider Public Health Qualitative Methods Race Randomized Research Research Design Sampling Social Workers Specific qualifier value Subgroup Surveys Team Nursing Terminal Disease Testing Training and Education Treatment Efficacy United States National Institutes of Health Variant Voice Work case finding clinical data warehouse clinical implementation comparative efficacy comparison control comparison intervention computerized decision-making capacity dementia care design efficacy outcomes efficacy testing empowerment evidence base experience health care service utilization high risk population hospice environment implementation evaluation implementation outcomes improved medical specialties member mortality risk neurodegenerative dementia portability preference primary care clinic primary care clinician primary care provider primary care setting primary care team primary outcome randomized, clinical trials secondary analysis secondary outcome skills skills training treatment as usual trial comparing

项目摘要

Advance care planning (ACP) is the planning that takes place between healthcare team members and patients prior to the onset of serious illness to ensure a person receives medical care that aligns with their wishes and values. Alzheimer’s disease and Alzheimer’s disease related neurodegenerative dementias (AD/ADRD) are incurable, progressive and terminal diseases with unparalleled impact on the US healthcare system, patients, and families. Over 5 million Americans live with AD/ADRD, and people with AD/ADRD lose decision-making capacity years in advance of critical and serious medical illness. Clinicians must discern when and how people with AD/ADRD can express valid treatment preferences at all stages of AD/ADRD. Most people with AD/ADRD are managed by primary care team members who receive little education and training on dementia-specific ACP skills. Primary care teams, including physicians, advance practice providers, nurses and social workers, are well-positioned to empower people living with AD/ADRD (PLwD) and their families in ACP, yet lack critical dementia-specific ACP skills. Evidence-based ACP interventions for PLwD are rare, and no prior clinical trial addresses AD/ADRD ACP in primary care. Our experienced investigative team has demonstrated feasibility and preliminary efficacy of an AD ACP intervention (AD ACP Toolkit) for primary care teams. It includes both a 3- hour dementia-specific education and ACP communication skills training session and subsequent ACP implementation guidance. We will test whether our AD ACP intervention will enable primary care teams to better conduct goals of care (GOC) discussions more efficiently and thus increase the number of GOC discussions held as compared to controls. We will deliver the AD ACP Toolkit to 10 intervention primary care clinics and usual care to 10 control clinics using a computerized case-finding algorithm within a large integrated health care system. Our first aim is to conduct a trial comparing the AD ACP Toolkit to usual care on GOC discussions and other ACP measures (N=800). The second aim is to examine the 18-month healthcare utilization outcomes for all PLwD with >50% 5-year mortality risk between intervention and control (N=2,660). We will conduct secondary analyses to examine outcomes by key patient and team characteristics. Lastly, we will assess implementation via surveys in the intervention clinics (N=100) followed by interviews (N=60) to explain variations in those outcomes. This project addresses National Institute on Aging’s mission to improve care for older adults with AD/ADRD in primary care. This work will improve how to incorporate ACP approaches for aging-related conditions by primary care teams and may be adaptable to other outpatient specialties such as oncology or cardiology.

预先护理计划（ACP）是医疗团队之间进行的计划在严重疾病发作之前的成员和患者，以确保一个人接受医疗关心与他们的愿望和价值观保持一致的。阿尔茨海默氏病和阿尔茨海默氏病有关神经退行性痴呆症（AD/ADRD）是无法治愈的，进行性和终末疾病的对美国医疗保健系统，患者和家庭的无与伦比的影响。超过500万美国人与AD/ADRD一起生活，并且有广告/ADRD的人会提前几年失去决策能力严重和严重的医学疾病。临床医生必须辨别何时以及如何与 AD/ADRD可以在AD/ADRD的所有阶段表达有效的治疗偏好。大多数人 AD/ADRD由很少受过教育和培训的初级保健团队成员管理关于痴呆症特异性的ACP技能。包括医生在内的初级保健团队提前练习提供者，护士和社会工作者有良好的位置，以增强拥有广告/ADRD的人的能力（PLWD）及其家人在ACP中，但缺乏特定痴呆症的ACP技能。循证 PLWD的ACP干预措施很少，并且没有先前的临床试验解决AD/ADRD ACP 初级保健。我们经验丰富的调查团队证明了可行性和初步 AD ACP干预措施（AD ACP工具包）对初级保健团队的功效。它包括一个3- 小时痴呆症特定的教育和ACP沟通技巧培训课程以及随后的 ACP实施指导。我们将测试我们的AD ACP干预是否会启用主要护理团队更好地执行护理目标（GOC）讨论，从而增加与对照组相比，进行了GOC讨论的数量。我们将提供AD ACP工具包使用计算机化的10个干预初级保健诊所和通常的护理到10个控制诊所大型综合医疗保健系统中的病例调查算法。我们的第一个目的是进行在GOC讨论和其他ACP测量中，将AD ACP工具包与通常的护理进行了比较的试验（n = 800）。第二个目的是检查所有PLWD的18个月医疗保健利用结果干预和对照之间的5年死亡率> 50％（n = 2,660）。我们将进行次要分析以检查关键患者和团队特征的结果。最后，我们会的通过在干预诊所（n = 100）中的调查评估实施（n = 60）解释这些结果的变化。该项目针对国家研究所衰老的使命是改善初级保健广告/ADRD的老年人的护理。这项工作将改进如何通过初级保健团队合并与衰老相关状况的ACP方法并且可能适用于其他门诊专业，例如肿瘤学或心脏病学。