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

项目总结 老年急性和急性后跌倒预防干预(GAPcare)是一种有希望的紧急情况 部门(ED)启动干预措施，以减少老年人跌倒和就诊；GAPcare减少 6个月急诊室就诊次数减少了66%，全原因急诊室就诊次数减少了53%，住院次数减少了43%。因为GAPcare 在跌倒后立即开始，改变行为的动机很高。然而，GAPcare需要- 个人药剂师和理疗师(PTS)，这限制了可伸缩性到大型ED，这仅占 急症室就诊总数的43.8%。如果我们不能扩大干预范围，就会错失宝贵的预防机会 每年有280万老年人在急诊室寻求护理。我们的首要目标是扩大覆盖范围 通过在社区ED中测试视频远程医疗GAPcare(e-GAPcare)干预而不存在 药房和PT服务。这项研究的基本原理是，专家评估的远程医疗具有 已经在急诊室成功实施，表明GAPcare可以适应跌倒患者 谁将从药房和PT咨询中受益，但由于#年的人员配备限制而无法获得这些服务 农村或较小的社区急救队。我们的长期目标是防止老年人跌倒和医疗保健就诊。这个 此应用程序的总体目标是开发和测试针对跌倒的远程医疗干预，基于我们的 成功的GAPcare模式。我们的中心假设是，e-GAPcare将帮助急诊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 与患者共同制定的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(城市/郊区/农村)分层的远程保健，以深入了解实际考虑因素； (2)根据急诊科工作人员、病人和照顾者的反馈，完善GAPcare干预和研究方案； 以及(3)对最近跌倒的老年ED患者(n=40)进行单臂可行性研究以确定 如果他们能够完成跌倒风险评估和干预，以评估e- GAPcare。戈德伯格博士将获得一项更大规模、多中心的GAPCARE III试验的初步疗效估计。vbl.使用 电话通话和电子健康记录，我们将衡量随后的跌倒，以及6个月后的医疗保健就诊， 为我们随后的更大规模的多中心GAPCARE III试验提供初步疗效。 Goldberg博士的e-GAPcare首要目标是开发和测试基于ED的远程医疗干预， 减少反复跌倒和医疗保健就诊，并在 急诊医学和老年病学。为了实现这一目标，戈德伯格博士将与她的导师雷斯尼克博士合作 和兰尼提高她在定性研究、数字健康、纵向数据分析和临床方面的专业知识 试验方法。在成功完成拟议的研究后，我们将建立一个全面试点的社区- 针对跌倒老年人的独特健康需求而量身定做的知情远程健康干预。

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.