Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine
Primary Palliative Care for Emergency Medicine (PRIM-ER): Protocol for a Pragmatic, Cluster-Randomised, Stepped Wedge Design to Test the Effectiveness of Primary Palliative Care Education, Training and Technical Support for Emergency Medicine
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DOI：
10.1136/bmjopen-2019-030099
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发表时间：
2019-08-01
期刊：
影响因子：
2.9
通讯作者：
Zimny, Erin
中科院分区：
文献类型：
--
作者：
Grudzen, Corita R.;Brody, Abraham A.;Zimny, Erin
介绍急诊科（艾德）照顾社会上最脆弱的老年人谁目前与慢性疾病的恶化，在生命的尽头，但临床范式的重点是治疗急性病变。姑息治疗干预措施在艾德捕捉高危患者在危机时刻，可以显着改善以患者为中心的结果。本研究的目的是实施和评估初级姑息治疗急诊医学（PRIM-ER）艾德处置，医疗保健利用率和生存率在老年人与严重的ills.Methods和分析这是一个务实的，集群随机阶梯楔形试验的协议，以测试的有效性PRIM-ER在美国各地的35个ED。该干预措施包括四个核心组成部分：（1）以证据为基础的多学科初级姑息治疗教育;（2）基于模拟的研讨会;（3）临床决策支持;（4）审计和反馈。该研究分为两个阶段：试点阶段，以确保在两个地点的可行性，以及实施和评估阶段，我们在33个ED中实施干预措施并测试其有效性。使用医疗保险和医疗补助服务中心（CMS）数据，我们将评估约30万例患者的主要结局：艾德在急性护理环境中的处置、艾德访视后6个月内的医疗保健利用率和指数艾德访视后的生存率。分析还将确定与PRIM-ER.Ethics和传播机构审查委员会批准的影响的变化相关的网站，供应商和患者水平的特征，在纽约大学医学院获得评估CMS数据。美国国立卫生研究院、独立监测委员会和临床信息学咨询委员会也将提供监督。试验结果将在同行评审期刊上发表。试验注册号NCT 03424109;预结果
Introduction Emergency departments (ED) care for society's most vulnerable older adults who present with exacerbations of chronic disease at the end of life, yet the clinical paradigm focuses on treatment of acute pathologies. Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centred outcomes. This study aims to implement and evaluate Primary Palliative Care for Emergency Medicine (PRIM-ER) on ED disposition, healthcare utilisation and survival in older adults with serious illness.Methods and analysis This is the protocol for a pragmatic, cluster-randomised stepped wedge trial to test the effectiveness of PRIM-ER in 35 EDs across the USA. The intervention includes four core components: (1) evidence-based, multidisciplinary primary palliative care education; (2) simulation-based workshops; (3) clinical decision support; and (4) audit and feedback. The study is divided into two phases: a pilot phase, to ensure feasibility in two sites, and an implementation and evaluation phase, where we implement the intervention and test the effectiveness in 33 EDs over 2 years. Using Centers for Medicare and Medicaid Services (CMS) data, we will assess the primary outcomes in approximately 300 000 patients: ED disposition to an acute care setting, healthcare utilisation in the 6 months following the ED visit and survival following the index ED visit. Analysis will also determine the site, provider and patient-level characteristics that are associated with variation in impact of PRIM-ER.Ethics and dissemination Institutional Review Board approval was obtained at New York University School of Medicine to evaluate the CMS data. Oversight will also be provided by the National Institutes of Health, an Independent Monitoring Committee and a Clinical Informatics Advisory Board. Trial results will be submitted for publication in a peer-reviewed journal.Trial registration number NCT03424109; Pre-results