Development and validation of the Patient-Reported Outcome Measure - Older adult care Transitions from the Emergency Department (PROM-OTED) tool

项目总结/摘要 65岁及以上的人占急诊科（艾德）就诊人数的2200多万 每年。最近的努力，以减少不必要的住院后，艾德评价已导致 大约65%的老年艾德患者出院回家。ED后的脆弱时期 出院具有显著的临床和公共卫生重要性，因为它与增加的 发病率和死亡率以及计划外艾德复发和住院的可能性。尽管 在这一过渡时期，不良后果的发生率很高，关于这些经验和 老年人在从急诊室回家的过渡期间所面临的具体挑战。 患者在健康相关生活质量、功能障碍、沟通障碍方面的优先事项，以及 艾德出院后的特定症状对于告知临床对话和 制定针对老年人护理过渡的干预措施。 本提案的总体目标是采用一种顺序探索性混合方法， 制定并验证患者报告的结局指标-从艾德到老年人护理的转变 （PROM-OTED）工具，一种新的护理过渡PROM经历艾德出院护理的老年人 过渡。我们将通过以下两个目标来实现这一目标：1）开发PROM-OTED工具， 表征老年人优先考虑的艾德出院护理过渡的结果。我们将使用迭代 定性方法包括概念识别、概念排序的成员检查、认知 访谈问题的发展，和专家小组项目减少的修改德尔菲过程;和2） 对PROM-OTED工具进行内部有效性测试。我们将进行定量调查评估， 该工具在最近经历过艾德的老年人中的初始心理测量特性和可行性 出院护理过渡。 根据《国家老龄问题研究所：2020-2025年研究战略方向》， 这项提案的结果将提高我们对老龄化社会的需求的理解， 发展和政策决定。具体而言，这项工作将通过制定一项措施产生重大影响， 评估艾德中老年人优先考虑的结果目前是否得到满足，并确定 改善临床和研究领域。在获奖期间，候选人将获得相关的 技能，并从具有互补技能的资深临床研究人员的指导中受益。这 调查将作为未来NIA K奖申请的初步工作，符合 候选人在更大的国家艾德样本中评估PROM-OTED工具的长期目标，包括 阿尔茨海默病和相关痴呆症（ADRD）患者，随后发展护理过渡 干预措施，以帮助老年人成功地导航艾德出院护理过渡。

PROJECT SUMMARY / ABSTRACT Persons aged 65 years and older account for over 22 million emergency department (ED) visits annually. Recent efforts to reduce unnecessary hospitalizations following ED evaluation have resulted in approximately 65% of older adult ED patients being discharged home. This vulnerable time period post-ED discharge has significant clinical and public health importance as it has been associated with an increased likelihood of morbidity and mortality as well as unscheduled ED recidivism and hospital admission. Despite high rates of adverse outcomes in this period of transition, little is known regarding the experiences and specific challenges faced by older adults during transitions home from the ED. Having a clear understanding of patients' priorities regarding health-related quality of life, functional disability, communication barriers, and condition-specific symptoms after ED discharge is essential to inform clinical conversations and the development of interventions targeting care transitions for older adults. The overall objective of this proposal is to use a sequential exploratory mixed-methods approach to develop and validate the Patient Reported Outcome Measure - Older adult care Transitions from the ED (PROM-OTED) tool, a novel care transitions PROM for older persons experiencing ED discharge care transitions. We will achieve this objective with the following two aims: 1) To develop the PROM-OTED tool, characterizing outcomes of ED discharge care transitions prioritized by older persons. We will use an iterative qualitative approach including concept identification, member checking for concept ranking, cognitive interviewing for question development, and expert panel item-reduction by a modified Delphi process; and 2) To conduct internal validity testing of the PROM-OTED tool. We will perform quantitative survey evaluation of the tool's initial psychometric properties and feasibility among older persons who recently experienced an ED discharge care transition. In alignment with the “National Institute on Aging: Strategic Directions for Research, 2020-2025”, findings of this proposal will improve our understanding of the needs of an aging society to inform intervention development and policy decisions. Specifically, this work will have significant impact by developing a measure to assess whether outcomes prioritized by older adults in the ED are currently met and identify opportunities for improvement in the clinical and research arenas. During the award period, the candidate will acquire relevant skills and benefit from mentorship by accomplished clinician-researchers with complementary skill sets. This investigation will serve as preliminary work towards a future NIA K award application, in line with the candidate's long-term objectives of assessing the PROM-OTED tool in a larger national ED sample, including those with Alzheimer's disease and related dementias (ADRD), and subsequently developing care transition interventions to help older adults successfully navigate ED discharge care transitions.