Improving Palliative Care Access Through Technology (ImPAcTT): A Multi-Component Pilot Study

点击翻译按钮获取中文摘要

PROJECT SUMMARY This K76 application will support Dr. Stephens’ continued progression to become a transformative interdisciplinary leader in aging and palliative care research who examines and promotes changes at the junctures of healthcare systems to improve access to palliative care services and supports for hard to reach nursing home (NH) populations. The Beeson Scholars program has been critical to her successes to date, but most importantly to her ability to secure this highly competitive endowed professor position at the University of Utah. She has assembled an excellent multidisciplinary team of mentors and scientific advisors which now includes faculty mentors/advisors from the University of Utah. Her team has the following areas of expertise: clinical geriatrics and palliative care (Drs. Ritchie, Lee, Supiano); implementation science (Dr. Ritchie, Lee); integrated care delivery models for frail elders (Drs. Ritchie, Ellington, Branagan); measuring and improving health care quality in NHs (Drs. Lee, Harrington, Ouslander); developing/evaluating patient-centered technologies, such as telehealth, for improving care for medically complex older adults (Drs. Ritchie, Branagan); statistical expertise on clinical trial design and analysis of complex datasets (Dr. Sheng); long term care health policy (Dr. Harrington); translational qualitative research methods (Dr. Shim); developing, testing and evaluating multi-component interventions in the NH setting (Dr. Ouslander). Suboptimal communication and lack of access to appropriate and timely palliative care expertise and support in the NH setting often leads to burdensome transitions, particularly at the end of life. Dr. Stephens’ research will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion. ImPAcTT employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities. In Aim 1, she will conduct semi- structured interviews with NH staff, residents and families to explore potential barriers and facilitators to using telehealth for increasing upstream access to PC expertise, support, and education. In Aim 2, she will assess the technical feasibility of telehealth to provide NH palliative care education and support, and develop and refine study protocols with up to 10 NH residents, families and staff. In Aim 3, she will conduct a pilot implementation trial in 4 NHs to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention. These studies will provide the scientific foundation for a compelling R01 application to evaluate the outcomes of this ImPAcTT intervention in a multi-site clinical trial.