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Covid-19大流行之前 开始社会距离。但是，关于医生实施远程医疗或 美国医生的吸收程度。迫切需要传播有用的远程医疗策略 该医生已雇用治疗老年人，尤其是残疾人（例如，视觉，听力， 移动性，认知），生活在设施中，数字知识或获得技术的访问有限。通过 - 与老年医生，初级保健和急诊医生的深度访谈，这是第一联系人 在Covid-19和随后的全国调查期间，我们提出了揭示这些策略，了解 全国远程医疗吸收范围，并传播我们的见解，这可以为医疗保健提供信息 老年人的转型。拟议研究的基础是医生的理由 自COVID-19开始并传播了经验教训以来，就有关远程医疗的重要发现 将确保将老年人的需求视为迅速转移到虚拟环境中，因此将其视为老年人的需求。没有 注意公平和利用照顾老年人的医生的见解，“数字鸿沟”将导致 已经存在医疗保健中的不平等现象，以牺牲老年人为代价。确定哪里 尚未实施远程医疗可能有助于集中意识努力。戈德堡博士将追求 以下两个具体目的：（1）与老年医生进行半结构化电话访谈（n = 36-54）， 初级保健和急诊医师（每个= 12-18），通过练习设置进行分层（地铁/郊区/农村 （n = 12-18））和类型（学术/社区（n = 18-27））探索远程医疗服务 提供/废弃的使用方式，促进者/障碍，实际考虑以及经验 向老年人提供远程护理。我们将在社交媒体平台上征求医生（Twitter， Facebook），以及通过专业协会列表服务。调查结果将为项目生成，减少和问题提供信息 调查的内容； （2）进行基于网络的老年医生，初级保健和紧急情况调查 医生（n = 1,600，每个专业的1％）使用美国医学协会的医师大师 估计远程医疗使用的范围，交付方法，采用障碍/挑战以及经验教训 为老年人提供护理。预计这项贡献将是重要的，因为选择医师 使他们的临床实践适应偏远环境 - 使用哪些模式，如何培训和评估 患者 - 可能决定老年人的需求和挑战是否被视为医疗保健的未来 交付成形。戈德堡博士的总体目的是确保老年人在 通过增强知识和培训医生在远程医疗中获得的知识和培训，以满足 大流行期间和之后患者的独特需求。这些目标的完成将为博士提供。 戈德堡（Goldberg）拥有远程医疗培训RCT的关键试点数据，该数据将以R01提交给NIA。