Development and Assessment of Diagnostic Accuracy of a Telemedicine-Based Delirium Assessment Tool (The Tele-CAM)

基于远程医疗的谵妄评估工具（Tele-CAM）的诊断准确性的开发和评估

基本信息

批准号：
10575167
负责人：
Charles Adrian Austin
金额：
$ 24.86万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
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：
2023-02-01 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10575167
关键词：
Activities of Daily Living Acute Adverse drug event Age Area Under Curve Assessment tool Attention Blood Vessels COVID-19 pandemic Cardiac Caregivers Cellular Phone Cessation of life Characteristics Clinical Clinical Research Cognition Cognition Disorders Confusion Delirium Dementia Detection Deterioration Development Devices Diagnostic Discipline of Nursing Early Diagnosis Elderly Enrollment Event Family Goals Home Home Health Aides Home environment Hospital Mortality Hospitalization Hospitals Impaired cognition Infection Inpatients Institution Institutionalization Intervention Interviewer Knowledge Length of Stay Life Malignant Neoplasms Medical Medicine Methods Myocardial Infarction Operative Surgical Procedures Outcome Participant Patient Discharge Patient-Focused Outcomes Patients Performance Persons Pharmaceutical Preparations Pilot Projects Population Postoperative Period Predictive Value Prevalence Prospective, cohort study Recovery of Function Reference Standards Rehabilitation therapy Research Research Personnel Resolution Risk Sensitivity and Specificity Sepsis Skilled Nursing Facilities Specificity Stroke Tablet Computer Telemedicine Testing Time Videoconferencing Work acceptability and feasibility acute care austin brain dysfunction clinical care clinical diagnosis cognitive testing confusion assessment method cost diagnostic accuracy diagnostic strategy disability experience feasibility testing functional decline heart function hospital readmission inattention innovation interest mortality mortality risk new technology remote assessment remote diagnosis statistics tool

项目摘要

PROJECT SUMMARY The overarching objective of this project is to develop and establish the diagnostic accuracy of a telemedicine- based delirium assessment tool, the TELE-CAM. Delirium, an acute change in cognition and attention is associated with a variety of undesirable outcomes including increased in-hospital mortality, long-term cognitive decline that mimics dementia, and increased risk for institutionalization. Delirium is prevalent in the post-operative population, and prevalence increases with age. Recent work performed by Dr. Austin and his research team demonstrated that many subjects were discharged home with active delirium. Patients discharged with active delirium to a nursing facility have worse outcomes than non-delirious patients. Despite the known negative effects of delirium in the post-acute care institution population, little is known about the impact of persistent delirium on functional recovery after discharge to the home setting. Current clinical diagnosis of delirium requires a face-to-face encounter, which limits the ability to feasibly perform frequent delirium assessments in the post-discharge setting. Over the past few years, devices that support videoconferencing, such as smart phones, have become commonplace. Concurrently, interest in telemedicine and remote diagnoses of cognitive disorders has grown. This interest has become even more acute due to the ongoing COVID-19 pandemic. We hypothesize that currently available videoconferencing capabilities can be easily and quickly utilized to perform reliable delirium assessments in older adults in the home setting. This project will refine and assess the diagnostic accuracy of a telemedicine-based delirium assessment tool based on the CAM (the TELE-CAM) that can be utilized in the home setting and assessed by remote researchers. We propose a prospective cohort study that will develop and refine this tool as well as demonstrate the feasibility of conducting in-home delirium assessments (Aim 1). We will also establish the diagnostic accuracy of our remote delirium assessment tool compared to a reference standard face-to-face assessment (Aim 2). We will enroll 400 older participants either hospitalized for an acute medical problem or major surgery for this project. The ability to perform in-home delirium assessments will prove invaluable to researchers investigating the appropriateness of discharging actively delirious patients’ home versus keeping them in the hospital until resolution of their delirium. Further, it will provide a method for clinicians to perform quick, remote delirium assessments of their patients.

项目概要该项目的总体目标是开发和建立远程医疗的诊断准确性基于谵妄的评估工具 TELE-CAM。谵妄是认知和注意力的急剧变化，与各种不良结果相关包括住院死亡率增加、类似痴呆症的长期认知能力下降以及风险增加谵妄在术后人群中很常见，并且患病率随着时间的推移而增加。奥斯汀博士和他的研究团队最近进行的研究表明，许多受试者都存在年龄问题。因活动性谵妄出院的患者因活动性谵妄出院后病情恶化。尽管谵妄在急性后护理中存在已知的负面影响，但结果仍优于非谵妄患者。对于机构人群中持续性谵妄对术后功能恢复的影响知之甚少。当前谵妄的临床诊断需要面对面的会诊。限制了在出院后环境中进行频繁谵妄评估的能力。在过去的几年里，支持视频会议的设备，例如智能手机，已经成为人们关注的焦点。与此同时，人们对远程医疗和认知障碍的远程诊断的兴趣也在增长。由于持续的 COVID-19 大流行，这种兴趣变得更加强烈。可以轻松快速地利用当前可用的视频会议功能来执行可靠的谵妄该项目将完善和评估家庭环境中老年人的诊断准确性。基于 CAM (TELE-CAM) 的远程医疗谵妄评估工具，可用于家庭环境并由远程研究人员进行评估。我们提出了一项前瞻性队列研究，该研究将开发和完善该工具并展示进行家庭谵妄评估的可行性（目标 1）我们还将确定诊断的准确性。我们的远程谵妄评估工具与参考标准面对面评估的比较（目标 2）。我们将招募 400 名因急性医疗问题住院或接受重大手术的老年参与者进行家庭谵妄评估的能力对于调查研究人员来说是无价的。将神志不清的患者送出家中与将其留在医院直到此外，它还将为忠诚者提供一种快速、远程执行谵妄的方法。对患者的评估。