Placing patient preferences at the center of care plans for older adults transitioning from the hospital to a skilled nursing facility

将患者偏好置于老年人从医院过渡到熟练护理机构的护理计划的中心

• 批准号: 10461863
• 负责人: James David Harrison
• 金额: $ 13.2万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10461863
• 关键词: Adopted; Aging; American; Behavior; California; Caregivers; Caring; Clinical; Collaborations; Communication; Communities; Creativeness; Data; Elderly; Elements; Ensure; Ethnography; Family; Foundations; Future; Geriatrics; Goals; Health care facility; Health system; Home; Hospitals; Impairment; Individual; Institutional Practice; Intervention; Interview; Lead; Length of Stay; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Outcome; Participant; Patient Preferences; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Phase; Preparation; Process; Prospective Studies; Provider; Qualitative Research; Recovery; Research; Research Methodology; Research Personnel; San Francisco; Scientist; Series; Skilled Nursing Facilities; Techniques; Testing; Time; Training; Transitional Care Planning; Trust; Universities; Vision; Voice; Work; acceptability and feasibility; care delivery; career; design; expectation; experience; health communication; hospital readmission; human centered design; human old age (65+); implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation tool; improved; improved outcome; innovation; leadership development; patient engagement; patient oriented; patient-clinician communication; person centered; pilot test; post implementation; preference; professor; programs; research and development; satisfaction; skills; theories; therapy development; tool; user centered design

PROJECT SUMMARY / ABSTRACT This is an application for a K01 Award for Dr. James Harrison, an Assistant Professor at the University of California San Francisco. Dr. Harrison’s career goal is to become an independent researcher in aging who uses patient engagement and implementation science to improve the outcomes of older adults transitioning from the hospital to skilled nursing facilities (SNFs). Dr. Harrison’s aspiration is for health systems to place older adults at the center of innovation discovery and care redesign. This K01 Award will help make this aspiration a reality by providing him with the training and research experience needed to develop and implement care transition interventions that are patient-centered and sustained in real-world settings. To facilitate successful completion of these activities, Dr. Harrison has assembled a strong mentorship team. His primary mentor is Dr. Margaret Fang, a clinical outcomes researcher who focuses on medications for vulnerable older adults. His co-mentors are Dr Rebecca Sudore, an expert in developing and testing tools to facilitate health communication for diverse older adults; Dr. Audrey Lyndon, an expert in qualitative research methods focusing on communication and teamwork; Dr Andrew Auerbach, an expert implementation scientist. Older adults comprise 75% of all hospital discharges to SNFs each year. Transition care planning remains persistently medicalized, failing to be guided by patients’ own preferences for their recovery, and does not incorporate elements that support preferences related to independence, returning home and function, or factors that allow participation in family or community activities that provide a foundation for personal purpose. An intervention to support patient and provider communication around patient preferences that can guide SNF transition planning is needed. In Aim 1, Dr. Harrison will conduct a qualitative grounded theory study to explore how patients and caregivers anticipate and are prepared for a SNF discharge. This study will also examine care team behaviors and processes that impact on how preferences are incorporated into transition plans. Aim 2 will involve co-developing a SNF preparation tool (SNF-PT) and associated implementation strategy with stakeholders using human centered design techniques. The objective of the SNF-PT will be to facilitate communication and implementation of patient preferences into SNF transition plans. In Aim 3, the SNF-PT will be piloted focusing on implementation outcomes and preliminary impacts on patient outcomes. This data will inform future R01 type-applications evaluating the SNF-PT. Through a focused program of mentored training and coursework, Dr. Harrison will gain skills in 1) Core principles of geriatrics, 2) The theory and application of advanced qualitative research methods (e.g. grounded theory), 3) User-centered design techniques to intervention development for older adults, and 4) Research leadership development. This K01 Award will provide Dr. Harrison with the expertise and data to launch his career as an independent investigator in aging focused on the hospital to SNF care transition.

项目摘要/摘要 这是该大学助理教授詹姆斯·哈里森博士的K01奖申请表 来自加利福尼亚州旧金山。哈里森博士的职业目标是成为一名研究老龄化的独立研究员 使用患者参与和实施科学来改善老年人过渡的结果 从医院到熟练的护理设施(SNF)。哈里森博士的抱负是让卫生系统 老年人处于创新发现和护理重新设计的中心。这个K01奖将有助于实现这一点 渴望成为现实，为他提供开发和研究所需的培训和研究经验 实施以患者为中心并在真实环境中持续的护理过渡干预措施。至 为了促进这些活动的顺利完成，哈里森博士组建了一支强大的指导团队。他的 主要导师是玛格丽特·方博士，她是一名临床结果研究员，专注于治疗 脆弱的老年人。他的合作导师是丽贝卡·苏多尔博士，她是开发和测试工具的专家 促进不同老年人的健康交流；定性研究专家奥黛丽·林登博士 方法侧重于沟通和团队合作；安德鲁·奥尔巴赫博士，专家实施科学家。 老年人占每年向SNF出院的所有患者的75%。过渡期护理规划 仍然坚持接受医疗治疗，没有按照患者自己的康复偏好进行指导，而且确实是这样 不包含支持与独立、回家和功能相关的偏好的元素，或者 允许参与为个人目的提供基础的家庭或社区活动的因素。 一种干预措施，支持患者和提供者围绕患者偏好进行沟通，可以指导SNF 过渡规划是必要的。在目标1中，哈里森博士将进行定性的扎根理论研究，以探索 患者和照顾者如何预期和准备SNF出院。这项研究还将检查 关心团队的行为和流程，这些行为和流程会影响偏好如何纳入过渡计划。目标 2将涉及共同开发SNF准备工具(SNF-PT)和相关的实施战略 利益相关者使用以人为本的设计技术。SNF-PT的目标是促进 将患者喜好传达并落实到SNF过渡计划中。在目标3中，SNF-PT将 将试点重点放在实施结果和对患者结果的初步影响上。此数据将 通知未来评估SNF-PT的R01类型应用程序。 通过有针对性的辅导培训和课程安排，哈里森博士将获得CORE方面的技能 老年病学原理，2)先进的定性研究方法的理论和应用(例如，扎根 理论)，3)以用户为中心的设计技术，以干预老年人的发展，以及4)研究 领导力发展。这一K01奖项将为哈里森博士提供专业知识和数据，以启动他的 作为老龄化方面的独立调查员，职业生涯专注于从医院到SNF护理的过渡。