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.

项目概要/摘要 这是该大学助理教授 James Harrison 博士的 K01 奖申请 加利福尼亚州旧金山。哈里森博士的职业目标是成为衰老领域的独立研究员 利用患者参与和实施科学来改善老年人过渡的结果 从医院到专业护理机构 (SNF)。哈里森博士的愿望是让卫生系统能够 老年人处于创新发现和护理重新设计的中心。 K01 奖将有助于实现这一目标 通过为他提供开发和研究所需的培训和研究经验，将愿望变为现实 实施以患者为中心并在现实环境中持续的护理过渡干预措施。到 为了顺利完成这些活动，哈里森博士组建了一支强大的导师团队。他的 主要导师是 Margaret Fang 博士，她是一位临床结果研究员，专注于药物治疗 弱势老年人。他的共同导师是 Rebecca Sudore 博士，她是开发和测试工具的专家。 促进不同老年人的健康沟通； Audrey Lyndon 博士，定性研究专家 注重沟通和团队合作的方法； Andrew Auerbach 博士是一位专家实施科学家。 每年，老年人出院人数占 SNF 出院人数的 75%。过渡护理计划 仍然坚持医疗治疗，未能以患者自己的康复偏好为指导，并且 不包含支持与独立、返回家园和功能相关的偏好的元素，或者 允许参与为个人目的奠定基础的家庭或社区活动的因素。 支持患者和提供者围绕患者偏好进行沟通的干预措施，可以指导 SNF 需要进行过渡规划。在目标 1 中，哈里森博士将进行定性扎根理论研究，以探索 患者和护理人员如何预期 SNF 出院并做好准备。这项研究还将考察 护理团队的行为和流程会影响如何将偏好纳入过渡计划。目的 2 将涉及与以下机构共同开发 SNF 准备工具 (SNF-PT) 和相关实施策略 利益相关者使用以人为本的设计技术。 SNF-PT 的目标是促进 将患者偏好沟通并落实到 SNF 过渡计划中。在目标 3 中，SNF-PT 将 试点重点关注实施结果和对患者结果的初步影响。该数据将 为未来评估 SNF-PT 的 R01 类型应用提供信息。 通过指导培训和课程的重点计划，哈里森博士将获得以下方面的技能：1) 核心 老年病学原理，2）先进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来干预老年人的发展，以及4）研究 领导力发展。 K01 奖将为哈里森博士提供专业知识和数据来启动他的研究 作为老龄化领域的独立调查员，她的职业生涯专注于医院向 SNF 护理的过渡。