GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare II：老年急性病

• 批准号: 10170870
• 负责人: Elizabeth Goldberg
• 金额: $ 6.63万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170870
• 关键词: Accident and Emergency department; Acute; Address; Adoption; Advisory Committees; American Medical Association; Attention; Awareness; COVID-19; COVID-19 pandemic; Caring; Clinical; Clinical Trials; Cognitive; Communities; Data; Dementia; Development; Disease; Educational Intervention; Elderly; Emergency Department Physician; Emergency Situation; Ensure; Environment; Evaluation; Facebook; Fall prevention; Future; Generations; Goals; Health; Health Promotion; Hearing; Home Blood Pressure Monitoring; Home environment; Interview; Investigation; Knowledge; Learning; Longevity; Medical; Methods; Midwestern United States; Monitor; Online Systems; Outcome; Patients; Personal Satisfaction; Physicians; Physiologic pulse; Positioning Attribute; Preventive care; Primary Health Care; Public Health; Publishing; Reporting; Research; Rural; Sensory; Services; Shapes; Social Distance; Societies; Structure; Surveys; Technology; Telephone; Telephone Interviews; Testing; Training; Twitter; Visit; Visual; Visual impairment; Work; acute care; age related; aging population; base; care coordination; clinical practice; coronavirus disease; design; digital; disability; effective intervention; experience; health care availability; health care delivery; improved; insight; medical specialties; pandemic disease; practice setting; preservation; prevent; programs; remote health care; smart watch; social media; suburb; telehealth; tool; uptake; virtual; virtual environment; wearable device; web portal

PROJECT SUMMARY Before the COVID-19 pandemic, only 4% of older adults used telehealth, but uptake has been rapid since the start of social distancing. However, little is known about physicians’ experiences implementing telehealth or the extent of uptake among US physicians. There is a critical need to disseminate useful telehealth strategies that physicians have employed to treat older adults, especially those with disabilities (e.g. visual, hearing, mobility, cognitive), living in facilities, with limited digital know-how or access to technology. Through in- depth interviews with geriatricians, primary care, and emergency physicians, who are the first point of contact during COVID-19, and a subsequent national survey, we propose revealing these strategies, understanding the scope of telehealth uptake nationally, and disseminating our insights which could inform healthcare delivery transformation for older adults. The rationale that underlies the proposed research is that physicians have made important discoveries about telehealth since the start of COVID-19 and disseminating lessons learned will ensure that older adult needs are considered as care is rapidly shifted to the virtual environment. Without attention to equity and leveraging insights of physicians that care for older adults, the “digital divide” will cause already existing inequities in medical care to further increase at the expense of older adults. Identifying where telehealth has not yet been implemented can be helpful to focus awareness efforts. Dr. Goldberg will pursue the following two specific aims: (1) conduct semi-structured telephone interviews (n=36-54) with geriatricians, primary care and emergency physicians (n=12-18 each), stratified by practice setting (metro/suburban/rural (n=12-18 each)) and type (academic/community (n=18-27 each)) to explore telehealth services provided/abandoned, modes of use, facilitators/barriers, practical considerations, and experiences with providing care remotely to older adults. We will solicit physicians on social media platforms (Twitter, Facebook), and via specialty society listserves. Findings will inform item generation, reduction, and question content for the survey; (2) conduct a web-based national survey of geriatricians, primary care and emergency physicians (n=1,600, 1% of each specialty) using the American Medical Association’s Physician Masterfile to estimate the scope of telehealth use, methods of delivery, barriers/challenges to adoption, and lessons learned delivering care to older adults. This contribution is expected to be significant because the choices physicians make in adapting their clinical practice to the remote environment - what modes to use, how to train and assess patients - are likely to dictate if older adults’ needs and challenges are considered as the future of healthcare delivery takes shape. Dr. Goldberg’s overarching aims are to ensure older adults receive medical care in the most suitable setting by enhancing the knowledge and training physicians receive in telehealth to meet the unique needs of their patients during and after the pandemic. The completion of these aims will provide Dr. Goldberg with critical pilot data for a telehealth training RCT which will be submitted as a R01 to the NIA.

项目摘要 在2019冠状病毒病大流行之前，只有4%的老年人使用远程医疗，但自2019年以来， 社交距离的开始。然而，很少有人知道医生的经验，实施远程保健或 美国医生的接受程度。迫切需要传播有用的远程保健战略 医生用来治疗老年人，特别是那些有残疾的人（例如视觉，听觉， 移动性、认知能力）、居住在设施中、数字知识或技术获取有限。穿过- 与老年病学家、初级保健和急诊医生进行深入访谈，他们是第一接触点 在COVID-19期间，以及随后的全国调查，我们建议揭示这些策略，了解 远程医疗在全国范围内的应用范围，并传播我们的见解，这些见解可以为医疗保健提供信息 老年人的转变。所提出的研究的基本原理是，医生 自COVID-19爆发以来，我们在远程医疗方面取得了重要发现，并传播了经验教训 将确保老年人的需求得到考虑，因为护理迅速转移到虚拟环境。没有 注意公平和利用医生的见解，照顾老年人，“数字鸿沟”将导致 医疗保健方面已经存在的不公平现象进一步加剧，损害了老年人的利益。标识在哪里 尚未实施的远程保健可能有助于集中提高认识的努力。金伯格医生会继续 以下两个具体目标：（1）与老年病医生进行半结构化电话访谈（n=36-54）， 初级保健和急诊医生（各n=12-18），按执业环境（都市/郊区/农村）分层 （各n=12-18））和类型（学术/社区（各n=18-27）），以探索远程保健服务 提供/放弃、使用模式、促进因素/障碍、实际考虑因素和 为老年人提供远程护理。我们将在社交媒体平台（Twitter， Facebook），并通过专业社会listserves。调查结果将告知项目生成、减少和问题 调查的内容;（2）对老年病医生、初级保健和急诊进行一次基于网络的全国调查 医生（n= 1，600，每个专业的1%）使用美国医学会的医生主文件， 估计远程保健的使用范围、提供方法、采用的障碍/挑战以及经验教训 为老年人提供护理。这一贡献预计将是显着的，因为选择医生 使他们的临床实践适应远程环境-使用什么模式，如何培训和评估 患者-可能决定是否将老年人的需求和挑战视为医疗保健的未来 交付成型。戈德堡博士的首要目标是确保老年人接受医疗保健， 通过加强医生在远程保健方面的知识和培训， 在大流行期间和之后满足患者的独特需求。这些目标的实现将为博士。 Goldberg为远程医疗培训RCT提供了关键的试点数据，该RCT将作为R 01提交给NIA。