A Safer Assisted Living: Creating a Toolkit for Person and Family Engagement

更安全的辅助生活：创建个人和家庭参与工具包

• 批准号: 10165789
• 负责人: Anna Song Beeber
• 金额: $ 8.39万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-04-09
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10165789
• 关键词: Safer; Assisted; Living; Creating; Toolkit

PROJECT SUMMARY/ABSTRACT Assisted living (AL), an alternative to nursing homes, provides housing, meals, 24-hour supervision, and, in some cases, health and supportive services. Unlike other healthcare settings, AL uses a social rather than medical model of care emphasizing a person-centered approach. However, while AL strives for person-centered care, resident acuity has been rising (e.g., functional decline; dementia), creating tension between supporting autonomy and minimizing risks from medication errors, infections, falls, and in cases of dementia, elopement and injuries. Similarly, the focus on person-centered practices (e.g., aging in place, well-being, quality of life) can be at odds with safety risks such as injury, elopement, or worsening chronic conditions. Discrepancies between the goals of residents/family and AL staff may result in disagreements, dissatisfaction with care, unnecessary treatments or hospital transfers. Thus, the core challenge of AL care lies in balancing person-centeredness with safety risks. A highly promising method for achieving this balance is person and family engagement (PFE). PFE refers to the person and family’s desire, ability, and activation as a partner with an individual (e.g., staff or healthcare provider), team, and/or setting to maximize outcomes and experience of care. Although PFE research is beginning to address non-hospital settings such as primary care and nursing homes, very little has been conducted in AL settings. Given the uniqueness of AL, one cannot assume that the approaches applicable to hospitals will directly apply to AL; therefore, in the proposed research, we will explore how to translate and adapt existing PFE work to the AL setting and develop a comprehensive toolkit to increase PFE in AL safety. Through a stakeholder-engaged, mixed methods study we will complete the following aims: AIM 1: Identify common AL safety problems. We will use structured interviews and surveys to identify AL safety problems (including how safety risks are balanced with person-centered care factors) and determining strategies to increase PFE in AL from the perspectives of: a) AL residents and family caregivers; and b) professional stakeholders; AIM 2: Rank AL safety problems and evaluate existing PFE interventions, tools, and strategies applied to other healthcare settings for their fit with AL. We will first do a web-based Delphi panel with a stakeholder panel to rank the AL safety problems and reconcile differences across stakeholder type. Our study team will then evaluate PFE interventions and tools that may apply to AL. The stakeholder panel will then reconvene to review these strategies and evaluate the fit with AL; and AIM 3: Develop a testable toolkit to improve PFE in AL safety. Using web-based focus groups with the AL stakeholder panel from Aim 2, we will match the ranked AL safety problems with the most promising PFE strategies (from Aim 2), identify new PFE strategies for AL safety, and identify and create essential components of the toolkit.

项目摘要/摘要 辅助生活(AL)是疗养院的替代方案，提供住房、餐饮、24小时监督，在一些情况下 病例、健康和支持性服务。与其他医疗保健设置不同，AL使用社交而不是医疗 强调以人为中心的护理模式。然而，在AL努力实现以人为中心的护理的同时， 居民的敏锐度一直在上升(例如，功能衰退；痴呆症)，在支持和支持之间造成了紧张 自主性，最大限度地减少用药错误、感染、跌倒以及在痴呆症情况下私奔的风险 和伤势。同样，对以人为中心的做法(例如，就地老龄化、福祉、生活质量)的关注可能 与受伤、私奔或日益恶化的慢性疾病等安全风险格格不入。两国之间的差异 住院医生/家属和AL工作人员的目标可能会导致不同意见、对护理不满意、不必要 治疗或医院转院。因此，AL护理的核心挑战在于平衡以人为本和 安全风险。实现这一平衡的一个非常有希望的方法是个人和家庭参与(PFE)。PFE 指个人和家庭作为个人(例如，员工或 医疗保健提供者)、团队和/或环境，以最大化护理结果和体验。尽管PFE研究 开始解决非医院环境，如初级保健和疗养院，但几乎没有 在AL设置中进行。鉴于AL的独特性，人们不能假设适用于 医院将直接应用于AL；因此，在拟议的研究中，我们将探索如何翻译和适应 现有的PFE适用于AL设置，并开发了一个全面的工具包，以提高AL的PFE安全性。穿过 一项利益相关者参与的混合方法研究，我们将完成以下目标：目标1：确定共同的AL 安全问题。我们将使用结构化访谈和调查来确定AL安全问题(包括如何 安全风险与以人为中心的护理因素平衡)和确定增加AL的PFE的策略 从以下角度：a)AL居民和家庭照顾者；以及b)专业利益攸关方；目标2：排名 AL安全问题并评估适用于其他医疗保健的现有PFE干预措施、工具和战略 他们与AL匹配的设置。我们将首先做一个基于网络的Delphi小组，其中有一个利益相关者小组来对AL进行排名 安全问题和协调不同利益相关者类型的差异。然后我们的研究小组将评估PFE 可能适用于AL的干预措施和工具。利益相关者小组随后将重新召开会议，审查这些 策略和评估与AL的匹配性；以及目标3：开发可测试的工具包以提高AL的PFE安全性。vbl.使用 基于网络的焦点小组与来自Aim 2的AL利益相关者小组，我们将匹配排名的AL安全问题 使用最有希望的PFE策略(来自目标2)，确定AL安全的新PFE策略，并确定和 创建工具包的基本组件。