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.

新型冠状病毒病2019（COVID-19）强调了提前护理计划的重要性 (ACP)对于最有死亡风险的老年患者，迫切需要优化这一过程。ACP 使患者能够表达他们的价值观和目标的护理之前，他们变得太生病这样做。ACP也 准备病人，和他们的家人，在真实的时间作出困难的决定时，时刻出现。老年 患者，COVID-19可能导致呼吸衰竭和高死亡率。然而，许多老年患者 可能更愿意避免这些干预措施，特别是如果死亡率很高，死亡是在 医院附近没有家人。受COVID-19对老年患者的不成比例风险的影响， 死亡率越高，初级保健临床医生应让所有年龄较大的ACP患者参与，以确保他们 偏好是已知的和尊重的。不幸的是，许多临床医生没有接受过ACP和患者的培训， 不熟悉它。 为了弥补这一差距，我们制定了针对COVID-19的全面远程医疗ACP计划 它将ACP常规地应用于医疗护理，并响应当前对虚拟通信的需求。 ACP计划结合了两种经过充分测试的、基于证据的互补干预措施： 临床医生沟通技能培训和ACP患者视频决策辅助。本报告的总体目标 应用是为了减轻COVID-19的负担及其对美国老龄化人口的影响， 他们宁愿放弃积极的、可能无效的干预措施，并在医院外死亡。到 为了实现这一点，我们建议使用远程医疗ACP的开放队列设计进行前后试验 在全国COVID-19震中纽约的老年患者中开展的项目。我们将培训250名初级保健人员， 来自纽约最大的医疗保健系统的25，000名65岁以上的不同患者的临床医生 （Northwell Health）我们将使用自然语言处理从电子邮件中提取我们的结果。 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 沟通技能培训与ACP视频相结合，将提高和维持ACP的比率， 与干预之前的时间相比，实施干预。 临床医生沟通培训和视频决策支持是一个实用的，循证的， 以创新方式统一提供强有力的非加太。这项建议的主要优点是： 经验丰富的团队使该项目可行;目前的基础设施已经嵌入在Northwell 健康，其中有最多的COVID-19患者在美国;和，潜在的直接 如果成功，在全国范围内部署干预措施。这项工作有望改善 在COVID-19大流行期间为数百万美国人提供的护理质量。