A Telehealth Advance Care Planning Intervention for COVID-19 in New York City

纽约市针对 COVID-19 的远程医疗预先护理计划干预

• 批准号: 10170786
• 负责人: James A. Tulsky
• 金额: $ 240.6万
• 依托单位: DANA-FARBER CANCER INST
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10170786
• 关键词: Address; Advance Care Planning; Aging; American; COVID-19; COVID-19 pandemic; Caring; Cessation of life; Communication; Consultations; Country; Critical Illness; Decision Aid; Decision Making; Documentation; Effectiveness; Electronic Health Record; Elements; Ensure; Equilibrium; Family; Feeling; Goals; Grant; Health; Health system; Healthcare Systems; Hospitals; Infrastructure; Intervention; Intubation; Life; Loneliness; Measures; Mechanical ventilation; Medical; Minority; Minority Groups; Natural Language Processing; New York; New York City; Outcome; Palliative Care; Patient Care Planning; Patient-Centered Care; Patient-Focused Outcomes; Patients; Population; Primary Health Care; Quality of Care; Randomized Controlled Trials; Respiratory Failure; Resuscitation; Resuscitation Orders; Risk; Technology; Testing; Time; Training; Work; acute care; cohort; comparison intervention; design; effectiveness evaluation; end of life; end of life care; evidence base; experience; hospice environment; human old age (65+); improved; innovation; loved ones; mortality; novel coronavirus; older patient; pandemic disease; patient health information; patient-clinician communication; pragmatic trial; preference; process optimization; programs; response; satisfaction; skills; skills training; success; telehealth; tool; virtual

The novel Coronavirus Disease 2019 (COVID-19) has highlighted the importance of advance care planning (ACP) for older patients who are most at risk of dying, and a critical need exists to optimize this process. ACP empowers patients to express their values and goals for care before they become too ill to do so. ACP also prepares patients, and their families, to make difficult decisions in real time when the moment arises. For older patients, COVID-19 may result in respiratory failure and high mortality rates. However, many older patients may prefer to avoid these interventions, especially if the mortality rate is high and death is experienced alone in the hospital without family nearby. Motivated by the disproportionate risk to older patients from COVID-19 and the higher mortality rates, primary care clinicians should engage all older patients with ACP to ensure their preferences are known and honored. Unfortunately, many clinicians have not been trained in ACP and patients are unfamiliar with it. To address this gap, we have developed a Comprehensive Telehealth ACP Program for COVID-19 that implements ACP routinely into medical care and responds to the present need for virtual communication. The ACP Program combines two well-tested, evidence-based, and complementary interventions: online clinician communication skills training and ACP patient video decision aids. The overall objective of this application is to reduce the burden of COVID-19 and its consequences for an aging US population that may prefer to forgo aggressive potentially ineffective interventions, and to die outside of the hospital setting. To accomplish this, we propose to conduct a Pre-Post trial using an open cohort design of a telehealth ACP Program among older patients in the nation's COVID-19 epicenter, New York. We will train 250 primary care clinicians caring for 25,000 diverse patients over the age of 65 from the largest health care system in New York (Northwell Health). We will use Natural Language Processing to abstract our outcomes from the electronic health records for patients. We hypothesize that a telehealth ACP Program of clinician serious illness communication skills training combined with ACP videos will improve and sustain rates of ACP from the time that the intervention is implemented compared to the time prior to the intervention. Clinician communication training and video decision support is a practical, evidence-based, and innovative approach to uniformly provide robust ACP. Major strengths of this proposal are: the highly experienced team making this project feasible; the present infrastructure already embedded at Northwell Health, which has the largest number of COVID-19 patients in the US; and, the potential immediate deployment of the intervention, if successful, across the country. This work holds the promise of improving the quality of care provided to millions of Americans during the COVID-19 pandemic.

新的冠状病毒疾病2019(新冠肺炎)强调了提前护理计划的重要性 (ACP)适用于死亡风险最大的老年患者，迫切需要优化这一过程。ACP 使患者能够在病得太重之前表达他们的价值观和护理目标。机场核心计划亦包括 让患者和他们的家人做好准备，以便在关键时刻做出实时的艰难决定。对于较老的人 对于患者，新冠肺炎可能会导致呼吸衰竭和高死亡率。然而，许多年龄较大的患者 可能倾向于避免这些干预措施，特别是如果死亡率很高，并且死亡是单独在 医院附近没有家人。动机是新冠肺炎和卵巢癌对老年患者的不成比例风险 死亡率越高，初级保健临床医生应该让所有老年ACP患者参与进来，以确保他们的 偏好是已知的，也是尊重的。不幸的是，许多临床医生没有接受过ACP和患者的培训 对它并不熟悉。 为了解决这一差距，我们为新冠肺炎开发了一个全面的远程医疗ACP计划 它将ACP例行公事地实施到医疗保健中，并回应了当前对虚拟通信的需求。 ACP计划结合了两种经过充分测试、基于证据和互补的干预措施：在线 临床医生沟通技能培训和非典患者视频决策辅助。这样做的总体目标是 申请是为了减轻新冠肺炎的负担及其对美国老龄化的后果，这可能会 宁愿放弃激进的、可能无效的干预措施，也不愿死在医院之外。至 要做到这一点，我们建议使用远程医疗ACP的开放队列设计进行一项事前和事后试验 在美国新冠肺炎的震中纽约，老年患者参与了这项计划。我们将培训250名初级保健人员 从纽约最大的医疗保健系统为25,000名65岁以上的不同患者提供护理的临床医生 (Northwell Health)。我们将使用自然语言处理从电子文档中提取我们的结果 病人的健康记录。我们假设临床医生严重疾病的远程医疗ACP计划 沟通技能培训结合ACP视频将从那时起提高并维持ACP的比率 实施干预的时间与干预前的时间相比较。 临床医生沟通培训和视频决策支持是一种实用、循证和 统一提供强大的ACP的创新方法。这项建议的主要优点是：高度 经验丰富的团队使该项目可行；目前的基础设施已经嵌入诺斯韦尔 Health，它拥有美国最多的新冠肺炎患者；以及，潜在的即时 如果成功，将在全国部署干预措施。这项工作有望改善 在新冠肺炎大流行期间为数以百万计的美国人提供的护理质量。