READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations

READI-SET-GO：研究谵妄识别的有效方法 - 维持有效的翻译以创建老年友好型组织

基本信息

批准号：
10658578
负责人：
DONNA Marie FICK
金额：
$ 85万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-01 至 2028-05-31
项目状态：
未结题

项目摘要

ABSTRACT for READI-SET-GO Delirium has a devastating impact on older adults and their care partners. It is associated with in hospital adverse events (e.g., falls), declines in physical and cognitive function, nursing home placement and increased mortality. Despite its poor outcomes and high costs, < 50% of all delirium cases are detected in routine care. To address this challenge, in READI (Researching Efficient Approaches to Delirium Identification) we developed, validated, and field tested the Ultra-brief CAM (UB-CAM), a two-step delirium identification protocol that combines an ultra-brief 2-item screen (UB-2) with a validated diagnostic tool (3D-CAM). We enrolled 527 patients, avg. age 80 years, 35% with ADRD, at 2 study hospitals, performed reference standard delirium evaluations on 924 hospital days (153 with delirium), followed by blinded UB-CAM App-directed assessments by physicians, registered nurses, and certified nursing assistants. The UB-CAM was feasible (97% completion rate), brief (average 1 min 15 seconds), had overall accuracy of 89%, and performed well by all disciplines. We found similar positive results in the enriched subset of READI participants with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD). We simultaneously conducted qualitative research to understand barriers and facilitators to implementation of delirium screening. While READI substantially advanced the field, it did not test full scale implementation of screening among all hospitalized older adults. We now propose to take this critical next step in READI-SET-GO (READI—Sustaining Effective Translation to create Gero-Friendly Organizations) by integrating daily delirium screening using the UB-CAM into routine care for every older adult admitted to 6 acute medical/surgical units at 3 hospitals in 2 states. We will conduct a stepped-wedge implementation design, where UB-CAM screening will be launched at a new unit every 6 months over a 42-month study. We will utilize evidence-based implementation strategies and test fidelity, accuracy, sustainability, and impact. Using a pragmatic cohort of 20,000 older adults, plus a nested patient- oriented sample of 1050 older adults enriched for AD/ADRD, we propose the following Specific Aims, 1. To test the fidelity, accuracy, and sustainability of integrating daily nurse screening for delirium using the UB-CAM into routine care for all hospitalized older adults. 2. To evaluate the impact of UB-CAM delirium screening on patient and care partner centered outcomes and perceptions of care assessed at one month follow-up interviews. 3. To evaluate the impact of UB-CAM screening on rates of delirium complications (falls, pressure injury, aspiration) and adverse delirium management (psychoactive medication, restraint use). Findings from the proposed study will be readily adopted into clinical care and will directly inform best practices for delirium screening, particularly for vulnerable older individuals with AD/ADRD. Our results have the potential to make the hospital a safer place for older adults, improving outcomes and reducing distress.

准备就绪摘要谵妄对老年人及其护理伙伴具有毁灭性影响，这与住院有关。不良事件（例如跌倒）、身体和认知功能下降、疗养院安置以及增加尽管其结果不佳且成本高昂，但在常规护理中发现的谵妄病例仍占不到 50%。为了应对这一挑战，在 READI（研究谵妄识别的有效方法）中，我们开发、验证和现场测试了超简短 CAM (UB-CAM)，这是一种两步谵妄识别协议结合了超简短的 2 项筛查 (UB-2) 和经过验证的诊断工具 (3D-CAM)，我们招募了 527 名患者。 2 家研究医院的患者，平均年龄 80 岁，35% 患有 ADRD，进行了参考标准谵妄治疗对 924 个住院日（其中 153 个为谵妄）进行评估，然后进行盲法 UB-CAM 应用程序指导评估由医生、注册护士和认证护理助理进行的 UB-CAM 是可行的（完成率 97%）。率），简短（平均 1 分 15 秒），总体准确率为 89%，所有学科都表现良好。在患有阿尔茨海默病的 READI 参与者的丰富子集中发现了类似的积极结果我们同时对阿尔茨海默病相关痴呆症（AD/ADRD）进行了定性研究。在 READI 期间充分了解实施谵妄筛查的障碍和促进因素。该领域虽然先进，但并未测试在所有住院老年人中全面实施筛查。我们现在建议在 READI-SET-GO（READI-Sustaining effective Translation to 通过将使用 UB-CAM 的日常谵妄筛查纳入日常护理，创建老年友好型组织对于 2 个州 3 家医院的 6 个急症医疗/外科病房收治的每一位老年人，我们将进行一次调查。阶梯式楔形实施设计，每 6 个新单元将启动 UB-CAM 筛选我们将利用基于证据的实施策略并测试保真度，进行为期 42 个月的研究。使用由 20,000 名老年人组成的务实队列以及嵌套的患者—— 针对 1050 名患有 AD/ADRD 的老年人的样本，我们提出以下具体目标， 1. 测试整合日常护士谵妄筛查的保真度、准确性和可持续性将 UB-CAM 用于所有住院老年人的日常护理。 2. 评估 UB-CAM 谵妄筛查对以患者和护理伙伴为中心的影响在一个月的后续访谈中评估护理结果和看法。 3. 评估 UB-CAM 筛查对谵妄并发症（跌倒、压力损伤、误吸）和不良谵妄管理（精神活性药物、约束使用）。拟议研究的结果将很容易应用于临床护理，并将直接提供最佳信息谵妄筛查的实践，特别是对于患有 AD/ADRD 的弱势老年人。有可能使医院成为老年人更安全的地方，改善治疗结果并减少痛苦。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A pilot study testing the iOS UB-CAM delirium app.

一项测试 iOS UB-CAM delirium 应用程序的试点研究。

DOI：
发表时间：
2023-06
期刊：
影响因子：
6.3
作者：
Kuzmik, Ashley;Hannan, John;Boltz, Marie;Shrestha, Priyanka;Husser, Erica K;Fick, Donna M;Marcantonio, Edward R
通讯作者：
Marcantonio, Edward R

Less Really Is More in Inappropriate Medication Use in Older Adults: How Can We Improve Prescribing and Deprescribing in Older Adults?

老年人不适当用药的少即是多：我们如何改善老年人的处方和取消处方？

DOI：
发表时间：
2020
期刊：
影响因子：
6.3
作者：
Fick; Donna M
通讯作者：
Donna M

The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge.

谵妄与痴呆的诊断：一个新的挑战。

DOI：
发表时间：
2017
期刊：
影响因子：
7.6
作者：
Morandi, Alessandro;Davis, Daniel;Bellelli, Giuseppe;Arora, Rakesh C;Caplan, Gideon A;Kamholz, Barbara;Kolanowski, Ann;Fick, Donna Marie;Kreisel, Stefan;MacLullich, Alasdair;Meagher, David;Neufeld, Karen;Pandharipande, Pratik P;Richardson, Sa
通讯作者：
Richardson, Sa

Determinants of Potentially Inappropriate Medication Use among Community-Dwelling Older Adults.

社区老年人潜在不适当用药的决定因素。

DOI：
发表时间：
2017-08
期刊：
影响因子：
3.4
作者：
Miller, G Edward;Sarpong, Eric M;Davidoff, Amy J;Yang, Eunice Y;Brandt, Nicole J;Fick, Donna M
通讯作者：
Fick, Donna M

Pay attention! The critical importance of assessing attention in older adults with dementia.

注意！

DOI：
发表时间：
2012-11
期刊：
影响因子：
0
作者：
Kolanowski, Ann M;Fick, Donna M;Yevchak, Andrea M;Hill, Nikki L;Mulhall, Paula M;McDowell, Jane A
通讯作者：
McDowell, Jane A