The design and conduct of a pragmatic cluster randomized trial of an advance care planning program for nursing home residents with dementia.
The design and conduct of a pragmatic cluster randomized trial of an advance care planning program for nursing home residents with dementia.
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针对患有痴呆症的疗养院居民的预先护理计划计划的务实群集随机试验的设计和行为。
DOI：
10.1177/17407745221108992
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发表时间：
2022-12
期刊：
影响因子：
--
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中科院分区：
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相当多患有阿尔茨海默病或相关痴呆诊断的人将在临终前在养老院接受照顾。预先护理计划（ACP）是一个以患者为中心的护理偏好的过程，被认为是为这一人群提供高质量护理的必要条件。目前，法规要求养老院向居民和家庭提供ACP，但对养老院工作人员没有培训要求，履行这一监管和道德责任的方法也各不相同。因此，居民可能会得到与他们的目标不一致的护理，例如不必要的住院治疗。务实的试验提供了一种在现实环境中发展和测试ACP的方法，以增加采用可持续最佳做法的可能性。“调整患者偏好——为阿尔茨海默病患者、护理人员和医疗保健提供者提供教育和支持（approach）”项目旨在对两家养老院公司旗下137家养老院（68家=干预，69家=对照）中由员工主导的项目进行务实的测试和评估。现有的养老院工作人员接受标准化的培训，并在公司领导的监督下实施ACP专家计划。试验的主要结果是每年的医院转院率（入院和急诊）。与务实的试验精神相一致，研究结果依赖于为提高质量、临床或计费目的而收集的数据。还将执行配置分析，以确定与实现相关的条件。与大公司的合作使approach试验能够依靠公司基础设施来推出干预措施，并得到公司实施负责人的支持，该负责人负责最初的介绍和对养老院ACP专家的持续支持。这些内部拥护者将项目与公司的其他优先事项联系起来，并使用养老院领导熟悉的策略来启动其他项目。养老院的标准化数据收集也支持在这种情况下进行实用试验。许多改善养老院护理的干预措施未能显示出影响，或者即使成功，也无法长期保持影响。实用试验，旨在测试干预措施在现实世界的背景下，通过现有的数据来源作为临床护理的一部分常规收集评估，非常适合养老院的环境。一个强大的计划，增加ACP对养老院居民的访问，有可能增加目标一致的护理，并有望减少医院转院。如果取得成功，ACP专家项目将迅速转化为养老院实践，以减少不必要的、繁重的住院治疗，提高痴呆症患者的护理质量。
A significant number of people with Alzheimer’s disease or related dementia diagnoses will be cared for in nursing homes near the end of life. Advance care planning (ACP), the process of eliciting and documenting patient-centered preferences for care, is considered essential to providing high quality care for this population. Nursing homes are currently required by regulations to offer ACP to residents and families, but no training requirements exist for nursing home staff and approaches to fulfilling this regulatory and ethical responsibility vary. As a result, residents may receive care inconsistent with their goals, such as unwanted hospitalizations. Pragmatic trials offer a way to develop and test ACP in real world settings to increase the likelihood of adoption of sustainable best practices. The “Aligning Patient Preferences – a Role Offering Alzheimer’s patients, Caregivers, and Healthcare providers Education and Support (APPROACHES)” project is designed to pragmatically test and evaluate a staff-led program in 137 nursing homes (68 = intervention, 69 = control) owned by two nursing home corporations. Existing nursing home staff receive standardized training and implement the ACP Specialist program under the supervision of a corporate lead. The primary trial outcome is the annual rate of hospital transfers (admissions and emergency department visits). Consistent with the spirit of a pragmatic trial, study outcomes rely on data already collected for quality improvement, clinical or billing purposes. Configurational analysis will also be performed to identify conditions associated with implementation. Partnerships with large corporate companies enable the APPROACHES trial to rely on corporate infrastructure to roll out the intervention, with support for a corporate implementation lead who is charged with the initial introduction and ongoing support for nursing home based ACP Specialists. These internal champions connect the project with other company priorities and use strategies familiar to nursing home leaders for the initiation of other programs. Standardized data collection across nursing homes also supports the conduct of pragmatic trials in this setting. Many interventions to improve care in nursing homes have failed to demonstrate an impact or, if successful, maintain impact over time. Pragmatic trials, designed to test interventions in real-world contexts that are evaluated through existing data sources collected routinely as part of clinical care, are well-suited for the nursing home environment. A robust program that increases access to ACP for nursing home residents has the potential to increase goal-concordant care and is expected to reduce hospital transfers. If successful, the ACP Specialist Program will be primed for rapid translation into nursing home practice to reduce unwanted, burdensome hospitalizations and improve quality of care for residents with dementia.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1111/j.1532-5415.2009.02304.x
发表时间：
2009-07-01
影响因子：
6.3
作者：
Givens, Jane L.;Kiely, Dan K.;Mitchell, Susan L.
通讯作者：
Mitchell, Susan L.
DOI：
10.1111/j.1532-5415.2011.03629.x
发表时间：
2011-11-01
影响因子：
6.3
作者：
Hanson, Laura C.;Carey, Timothy S.;Mitchell, Susan L.
通讯作者：
Mitchell, Susan L.
影响因子：
1.5
作者：
Christian, Jennifer B.;Brouwer, Emily S.;Dreyer, Nancy A.
通讯作者：
Dreyer, Nancy A.
定性比较分析：一种识别与程序有效性相关的因素的混合方法。
影响因子：
3.9
作者：
Cragun D;Pal T;Vadaparampil ST;Baldwin J;Hampel H;DeBate RD
通讯作者：
DeBate RD