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.

项目摘要 老年急性和急性后跌倒预防干预（GAPcare）是一个有希望的紧急情况 一个部门（艾德）启动了干预措施，以减少老年人的福尔斯跌倒和医疗保健就诊;减少了GAPcare 6-跌倒艾德月就诊率为66%，全因艾德就诊率为53%，住院率为43%。因为GAPcare 在跌倒发生后立即开始，改变行为的动机很高。然而，GAPcare要求在- 个人药剂师和物理治疗师（PT），这限制了大型ED的可扩展性，这些ED仅占 占所有艾德就诊的43.8%。如果我们不能扩大这一干预措施的规模， 2.8每年有数百万老年人因福尔斯摔倒而寻求护理。我们的终极目标是扩大 通过在社区艾德中测试视频远程医疗GAPcare（e-GAPcare）干预， 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 已经在ED中成功实施，这表明GAP护理可以适用于福尔斯患者 将受益于药房和PT咨询，但由于人员配置限制而无法接受 农村或较小的社区ED。我们的长期目标是预防老年人福尔斯跌倒和医疗保健。的 该应用程序的总体目标是开发和测试基于福尔斯的 成功的GAPCare模式。我们的中心假设是e-GAPcare将帮助艾德临床医生识别跌倒风险 因素，如步态，平衡和认知障碍，并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跌倒的计划。 GAPcare的具体目标是：（1）与内容专家进行半结构化访谈（n=18-24）， 按实践环境（都市/郊区/农村）分层的远程保健，以了解实际考虑因素; (2)根据艾德工作人员、患者和护理人员的反馈，完善GAP护理干预和研究方案; 和（3）对最近跌倒的老年艾德患者（n=40）进行单臂可行性研究，以确定 如果他们能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， GAPcare。Goldberg博士将获得一项更大的多中心GAPcare III试验的初步疗效估计。使用 电话和电子健康记录，我们将测量随后的福尔斯，以及6个月时的医疗访视， 为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一种基于ED的远程医疗干预， 减少经常性的福尔斯和医疗保健访问，并在以下交叉点开始她的医生-科学家职业生涯： 急诊医学和老年医学。为了实现这一目标，戈德堡博士将与她的导师雷斯尼克博士 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， 审判方法在成功完成拟议的研究后，我们将制作一个完全试点的社区- 根据患有福尔斯的老年人的独特健康需求量身定制的知情远程保健干预。