A Novel Method for Measuring Goal-Concordant Care in Seriously Ill Older Adults with Multiple Chronic Conditions

项目摘要/摘要 提供与目标一致的护理被认为是为重病老年人提供高价值护理的关键组成部分 患有多种慢性病(MCC)的成年人；然而，没有黄金标准来衡量。长的- 拟议工作的长期目标是促进重病老年人的质量测量科学 有姑息治疗需求的成年人。本应用程序的总体目标是开发一种心理测量学有效 患者报告体验测量(PREM)，衡量重病老年患者的目标一致性护理 成人MCC。其基本原理是，经过验证的PREM测量目标-一致性护理可以提供真正的- 提供以患者为中心的护理所需的时间反馈，以满足这一人群的动态需求， 同时作为提供姑息治疗的质量指标。拟议的工作将 通过三个具体目标完成总体目标：1)开发衡量目标的项目库- 重症老年MCC患者基于健康相关价值观领域的协调性护理；2) 运用项目反应理论评价题库和结果PREM的测量特性 现场测试数据的分析和重测可靠性；以及3)确定数据的可接受性、可行性和保真度 在初级保健中实施PREM。第一个目标是建立Prem的内容有效性，并且是 多方法定性研究包括：1)对患有严重疾病的老年人进行半结构化访谈 MCC及其PCP；2)电子病历中重病谈话记录的内容分析 使用自然语言处理识别的健康记录。从这个定性过程中出现的主题 将通知条目和量表的生成，并细化与目标相关的健康相关价值领域的层次结构 和谐的关怀。将通过与患者和老年人的重点小组进一步发展和完善项目 姑息治疗专家确定尚未涵盖的相关内容；与患者进行认知访谈以 编排项目的格式，并由研究小组对项目进行评审。第二个目标将建立Prem的可靠性和 结构效度，包括对患有MCC的重病老年人进行现场测试，然后进行心理测量 分析以开发和评估构成PREM的项目。在第三个目标下，40名患有重病的老年人 患有MCC的成年人将在48周内在初级保健诊所完成Prem，这是一项单臂试点研究， 评估PREM可接受性、可行性和保真度的多阶段混合方法设计 实施。这一提议具有创新性，因为它将开发第一个经过验证的Prem，该PREM 患有MCC的重病老年患者的目标一致性护理也可用于衡量 高级护理计划的有效性。这项工作意义重大，因为这个Prem将目标- 通过量化患者的体验，将协调的护理转化为可测量和可操作的结构 有效的护理流程支持患者实现自我和谐目标的能力。归根结底，这个首相 将有助于建立为患有MCC的重病老年人提供姑息治疗的质量标准。

PROJECT SUMMARY / ABSTRACT Delivering goal-concordant care is considered a key component of high-value care for seriously ill older adults with multiple chronic conditions (MCC); however, no gold standard for measurement exists. The long- term goal of the proposed work is to advance the science of quality measurement among seriously ill older adults with palliative care needs. The overall objective in this application is to develop a psychometrically valid patient-reported experience measure (PREM) that measures goal-concordant care among seriously ill older adults with MCC. The rationale is that a validated PREM measuring goal-concordant care can provide real- time feedback necessary to deliver patient-centered care that meets the dynamic needs of this population, while simultaneously functioning as a quality indicator for palliative care delivery. The proposed work will complete the overall objective through three specific aims: 1) develop an item pool that measures goal- concordant care based on domains of health-related values among seriously ill older adults with MCC; 2) evaluate measurement properties of the item pool and resultant PREM by conducting Item Response Theory analysis and test-retest reliability of field test data; and 3) determine the acceptability, feasibility, and fidelity of PREM implementation in primary care. The first aim establishes the PREM’s content validity and is a multimethod qualitative study consisting of: 1) semi-structured interviews with seriously ill older adults with MCC and their PCPs and 2) content analysis of serious illness conversation documentation in the electronic health record identified using natural language processing. Themes that emerge from this qualitative process will inform item and scale generation and refine the hierarchy of health-related value domains relevant to goal- concordant care. Items will be further developed and refined via focus groups with patients and geriatric palliative care experts to identify relevant content not already covered; cognitive interviews with patients to format the items; and item review by the study team. The second aim will establish the PREM’s reliability and construct validity and consists of field tests of seriously ill older adults with MCC followed by psychometric analyses to develop and evaluate the items comprising the PREM. Under the third aim, 40 seriously ill older adults with MCC will complete the PREM in a primary care clinic over 48 weeks in a single-arm pilot study with a multistage, mixed methods design to evaluate the acceptability, feasibility, and fidelity of PREM implementation. This proposal is innovative because it will develop the first validated PREM that measures goal-concordant care among seriously ill older adults with MCC that can also be used to measure the effectiveness of advanced care planning. This work is highly significant because this PREM transforms goal- concordant care into a measurable and actionable construct by quantifying the patient’s experience of how effectively care processes support the patient’s ability to attain self-concordant goals. Ultimately, this PREM will help establish a quality standard for palliative care delivery for seriously ill older adults with MCC.