Expanding the Reach of a Fall Prevention Intervention for Older Adult Emergency Department Patients through Telehealth

通过远程医疗扩大急诊科老年患者跌倒预防干预的范围

• 批准号: 10331948
• 负责人: Elizabeth Goldberg
• 金额: $ 40.7万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10331948
• 关键词: Accident and Emergency department; Acute; Age; Agreement; Calendar; Caregivers; Caring; Centers of Research Excellence; Cessation of life; Clinical; Clinical Trials; Communities; Computer software; Consult; Consultations; Data; Data Analyses; Development; Devices; Elderly; Electronic Health Record; Emergency Department patient; Emergency Medicine; Emergency department visit; Evaluation; Expenditure; Fall prevention; Feasibility Studies; Feedback; Funding; Future; Gait; Geriatrics; Goals; Health; Health Care Visit; Home; Hospitalization; Hospitals; Impaired cognition; Injury; Interest Group; Intervention; Intervention Studies; Interview; Measures; Mentors; Methodology; Methods; Modeling; Motivation; Neurologist; Nurses; Participant; Patients; Peer Review; Persons; Pharmacists; Pharmacy facility; Physicians; Population; Prevention; Primary Care Physician; Procedures; Process Measure; Protocols documentation; Qualitative Research; Quality of life; Randomized; Recommendation; Recurrence; Research; Review Literature; Rhode Island; Risk Assessment; Risk Factors; Rural; Rural Community; Sampling; Scientist; Services; Site; Specialist; Stroke; Structure; Suggestion; Technology; Telephone; Testing; Time; Urban Community; Work; acceptability and feasibility; arm; base; behavior change; care seeking; career; digital health; efficacy evaluation; equilibration disorder; fall injury; fall risk; falls; improved; insight; pharmacy benefit; physical therapist; practice setting; prevent; preventive intervention; primary care setting; promoter; recruit; suburb; suburban communities; telehealth; uptake; virtual; working group

PROJECT SUMMARY The Geriatric Acute and Post-Acute Fall Prevention Intervention (GAPcare) is a promising emergency department (ED) initiated intervention for reducing falls and healthcare visits in older adults; GAPcare reduced 6-month ED visits for falls by 66%, all-cause ED visits by 53%, and hospitalizations by 43%. Because GAPcare begins immediately after a fall occurs, motivation to change behavior is high. However, GAPcare requires in- person pharmacists and physical therapists (PTs), which limits scalability to large EDs, which account for only 43.8% of all ED visits. If we fail to scale this intervention, valuable prevention opportunities will be missed for the 2.8 Million older adults who seek care for falls in EDs each year. Our over-arching goal is to expand the reach of GAPcare by testing a video telehealth GAPcare (e-GAPcare) intervention in a community ED without existing pharmacy and PT services. The rationale for this research is that telehealth for specialist evaluations have already been successfully implemented in EDs, suggesting that GAPcare could be adapted for patients with falls who would benefit from pharmacy and PT consultation, but cannot receive them due to staffing limitations in rural or smaller community EDs. Our long-term goal is to prevent falls in older adults and healthcare visits. The overall objective of this application is to develop and test a telehealth intervention for falls based on our successful GAPcare model. Our central hypothesis is that e-GAPcare will help ED clinicians identify fall risk factors, such as gait, balance, and cognitive impairment and could ameliorate these risk factors through action plans co-created with patients preventing the next fall. GAPcare’s specific aims are to: (1) conduct semi-structured interviews (n=18-24) with content experts in telehealth stratified by practice setting (metro/suburban/rural) to gain insights about the practical considerations; (2) refine the GAPcare intervention and study protocol based on feedback from ED staff, patient and caregivers; and (3) conduct a single arm feasibility study with older adult ED patients (n=40) with a recent fall to determine if they can complete the fall risk assessment and intervention to assess the feasibility and acceptability of e- GAPcare. Dr. Goldberg will obtain initial estimates of efficacy for a larger, multi-center GAPcare III trial. Using phone calls and the electronic health record we will measure subsequent falls, and healthcare visits at 6 months, to inform initial efficacy for our subsequent larger, multi-center GAPcare III trial. Dr. Goldberg’s e-GAPcare overarching aims are to develop and test an ED-based telehealth intervention that reduces recurrent falls and healthcare visits and to launch her physician-scientist career at the intersection of emergency medicine and geriatrics. To achieve this goal, Dr. Goldberg will work with her mentors Drs. Resnik and Ranney to improve her expertise in qualitative research, digital health, longitudinal data analysis, and clinical trial methods. Upon successful completion of the proposed research, we will produce a fully piloted, community- informed telehealth intervention tailored to the unique health needs of older adults with falls.

项目概要 老年急性和急性跌倒后预防干预 (GAPcare) 是一项很有前途的紧急情况 部门（ED）发起干预措施，以减少老年人跌倒和医疗就诊； GAPcare 减少 6 个月内因跌倒而就诊的急诊人数减少了 66%，因各种原因就诊的急诊人数减少了 53%，住院治疗的人数减少了 43%。因为GAPcare 跌倒发生后立即开始，改变行为的动机很高。然而，GAPcare 需要- 私人药剂师和物理治疗师 (PT)，这限制了大型 ED 的可扩展性，而大型 ED 仅占 占所有急诊就诊的 43.8%。如果我们未能扩大这种干预措施的规模，那么人们就会错失宝贵的预防机会。 每年有 280 万老年人因跌倒而在急诊室寻求护理。我们的首要目标是扩大影响范围 通过在社区急诊室测试视频远程医疗 GAPcare (e-GAPcare) 干预来实施 GAPcare 药房和 PT 服务。这项研究的理由是，用于专家评估的远程医疗已经 已在急诊室成功实施，表明 GAPcare 可以适用于跌倒患者 谁可以从药房和 PT 咨询中受益，但由于人员配备限制而无法接受这些咨询 农村或较小的社区急诊室。我们的长期目标是防止老年人跌倒和就医。这 该应用程序的总体目标是开发和测试基于我们的跌倒远程医疗干预措施 成功的GAPcare 模式。我们的中心假设是 e-GAPcare 将帮助急诊科临床医生识别跌倒风险 步态、平衡和认知障碍等因素，可以通过行动改善这些风险因素 与患者共同制定预防下一次秋天的计划。 GAPcare 的具体目标是：(1) 与以下领域的内容专家进行半结构化访谈（n=18-24）： 按实践环境（地铁/郊区/农村）进行远程医疗分层，以获得有关实际考虑因素的见解； (2) 根据急诊科工作人员、患者和护理人员的反馈完善 GAPcare 干预和研究方案； (3) 对近期跌倒的老年 ED 患者 (n=40) 进行单组可行性研究，以确定 如果他们能够完成跌倒风险评估和干预，以评估电子化的可行性和可接受性 差距护理。 Goldberg 博士将获得一项更大规模、多中心 GAPcare III 试验的初步疗效估计。使用 我们将通过电话和电子健康记录来衡量随后的跌倒情况以及 6 个月时的医疗就诊情况， 为我们后续更大规模的多中心 GAPcare III 试验提供初步疗效信息。 Goldberg 博士的 e-GAPcare 总体目标是开发和测试基于 ED 的远程医疗干预措施 减少反复跌倒和医疗就诊，并在交叉领域开启她的医师科学家职业生涯 急诊医学和老年病学。为了实现这一目标，戈德堡博士将与她的导师 Drs.雷斯尼克 和 Ranney 提高她在定性研究、数字健康、纵向数据分析和临床方面的专业知识 试用方法。成功完成拟议的研究后，我们将制作一个全面试点的社区- 针对跌倒老年人的独特健康需求量身定制的知情远程医疗干预措施。