Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial.
Longitudinal, Interdisciplinary Home Visits Versus Usual Care for Homebound People With Advanced Parkinson Disease: Protocol for a Controlled Trial.
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纵向、跨学科家访与常规护理对晚期帕金森病患者的影响：一项对照试验方案
DOI：
10.2196/31690
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发表时间：
2021-09-14
影响因子：
1.7
通讯作者：
Chodosh J
中科院分区：
文献类型：
--
作者：
Fleisher JE;Hess S;Sennott BJ;Myrick E;Wallace EK;Lee J;Sanghvi M;Woo K;Ouyang B;Wilkinson JR;Beck J;Johnson TJ;Hall DA;Chodosh J
目前对晚期帕金森病(PD)及其治疗的了解很大程度上是基于门诊数据。最先进和残疾的帕金森氏症患者与护理和研究脱节。先前在老年、多发病的晚期帕金森病患者中进行的一项初步研究证明了跨学科家访的可行性，以接触到目标人群，提高护理质量，并有可能避免住院。这项研究的目的是调查跨学科家访是否可以防止帕金森病患者生活质量的下降和防止照顾者压力的恶化。该协议还探讨了与通常的医疗保健相比，在医疗保健利用和制度化方面的节省是否抵消了计划成本。在这项单中心对照试验中，65名受晚期帕金森病(Hoehn和Yahr阶段3-5和在家)影响的患者-照顾者双方被招募接受为期一年的季度跨学科家访。为期一年的干预由一名护士和一名研究协调员提供，他们前往家中，并由一名运动障碍专家和社会工作者(两者都通过视频出席)提供支持。每个二联体都与年龄、性别、Hoehn和Yahr阶段匹配的对照二联体进行比较，这些二元体来自纵向帕金森结局项目登记中的美国参与者。主要的结果衡量标准是患者的生活质量在基线和1年之间的变化。次要结果指标包括Hoehn和Yahr阶段的变化、照顾者压力、自我报告的跌倒频率、急诊室就诊、入院时间以及住院或死亡时间。将在预算影响分析中分析干预成本和卫生保健利用的变化，以探索模式调整和传播的潜力。该议定书于2017年9月获得资助，并于2017年10月获得Rush机构审查委员会的批准。招募于2018年5月开始，2019年11月结束，登记了65名患者-护理员双方。所有考察访问已完成，分析工作正在进行中。据我们所知，这是第一个调查家访对患有晚期帕金森病的患者及其照顾者的影响的对照试验。这项研究还建立了一个独特的患者队列，我们可以从中研究晚期帕金森病的自然病程、治疗方法和未得到满足的需求。ClinicalTrials.gov NCT03189459；http://clinicaltrials.gov/ct2/show/NCT03189459.PRR1-10.2196/31690
The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. PRR1-10.2196/31690
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家庭姑息治疗计划对医疗保健使用和成本的影响。
影响因子：
6.3
作者：
Brian Cassel J;Kerr KM;McClish DK;Skoro N;Johnson S;Wanke C;Hoefer D
通讯作者：
Hoefer D
影响因子：
2.1
作者：
Basu, A;Manning, WG;Mullahy, J
通讯作者：
Mullahy, J
影响因子：
7.2
作者：
Fitzpatrick, R;Norquist, JA;Jenkinson, C
通讯作者：
Jenkinson, C
影响因子：
9.9
作者：
GOETZ, CG;STEBBINS, GT
通讯作者：
STEBBINS, GT
影响因子：
--
作者：
Fleisher, Jori E.;Klostermann, Ellen C.;Chodosh, Joshua
通讯作者：
Chodosh, Joshua