Development and Pilot Testing of an Intervention to Support Interhospital Transfer Decisions (SITe) Regarding Older Adults with Emergency General Surgery Diagnoses

项目摘要 每年有近24万名65岁及以上的患者在急诊科（ED）之间转移 和非创伤性外科急诊医院。这些转移包括紧急普通外科手术 (EGS)诊断，如肠梗阻，憩室炎，软组织感染。转出患者 比那些直接从急诊室入院的患者的预后更差。一个促成因素 转移老年EGS患者的最坏结果是， 转账。转移分散护理，将老年患者与常规医疗保健提供者分开， 代理决策者和社会支持系统。合并症和急性疾病可以限制老年人 成年人的认知能力，以提供他们的健康史，并充分参与医疗决策。由于 由于这些威胁，转介和接受提供者之间的沟通对于决定转移老年人至关重要。 成年人了然而，首席研究员的数据显示，有关转移决定的对话是不完整的， 和不一致，导致护理协调不良，提供者之间的情绪劳动增加，缺乏 提供者之间关于转让决定的共识，以及可能避免的转让。 标准化住院单位之间医院间转移的费用有助于沟通， 改善患者护理和结果。类似地，标准化关于医院间转移的对话 这些决定有可能使老年患者受益。为了标准化有关转会决策的沟通， 我们将开发和试点测试一种干预措施，以支持医院间转移决策（SITE）， 满足老年EGS患者的需求，并通过以下目的利用现有的转移过程。目标1： 通过调整现有的 对医院间病人的干预。目标2：评估SITE干预的可接受性，测试 研究程序的可行性，并探索疗效结果，以供未来更大规模的临床试验评估。 我的长期目标是通过创新的护理研究来改善老年EGS患者的预后 协调和职业生涯作为一个独立资助，外科医生，科学家和临床领导者在交叉点 EGS和衰老研究的成果。该建议书包括一个全面的、量身定制的专业发展计划 它将指导和教育活动与经验研究相结合， 科学和专业，成为未来的领导者，在老龄化为重点的研究。我的才华和 专门的指导团队由临床研究人员组成，他们是衰老相关研究的领导者， 在医疗过渡、医疗提供者之间的沟通和干预发展方面的专业知识。这 一项提案将产生初步数据，以支持一项外部的R级临床试验，该试验将具有实质性的 影响，因为我们改善了供应商之间关于转移老年患者的决定的沟通。

Project Summary Every year, nearly 240,000 patients aged 65 and older are transferred between emergency departments (EDs) and hospitals for non-traumatic surgical emergencies. These transfers include emergency general surgery (EGS) diagnoses such as bowel obstructions, diverticulitis, and soft tissue infections. Transferred patients experience worse outcomes than those directly admitted from EDs within a given hospital. A contributing factor to the worse outcomes of transferred older EGS patients is that care coordination suffers during interhospital transfers. Transfers fragment care and separate older patients from their regular healthcare providers, surrogate decision makers, and social support systems. Comorbid conditions and acute illness can limit older adults’ cognitive capacity to provide their health history and fully participate in medical decision-making. Due to these threats, communication between referring and accepting providers is critical to decisions to transfer older adults. Yet, the Principal Investigator’s data show that conversations about transfer decisions are incomplete and inconsistent, resulting in poor care coordination, increased emotional labor among providers, a lack of consensus between providers about the transfer decision, and potentially avoidable transfers. Standardizing handoffs for interhospital transfers between inpatient units facilitates communication, resulting in improved patient care and outcomes. Similarly, standardizing conversations about interhospital transfer decisions has the potential to benefit older patients. To standardize communication about transfer decisions, we will develop and pilot-test an intervention to Support Interhospital Transfer decisions (SITe) that is specific to the needs of older EGS patients and utilizes extant transfer processes through the following aims. Aim 1: Engage key stakeholders to develop the SITe intervention for older EGS patients by adapting an existing intervention for interhospital handoffs. Aim 2: Assess the acceptability of the SITe intervention, test the feasibility of study procedures, and explore efficacy outcomes for evaluation in a future, larger clinical trial. My long-term goal is to improve outcomes for older EGS patients through innovative research on care coordination and a career as an independently funded, surgeon-scientist and clinical leader at the intersection of EGS and aging research. This proposal includes a comprehensive, tailored Professional Development Plan that combines mentorship and educational activities with experiential research that will prepare me scientifically and professionally to become a future leader in aging-focused research. My talented and dedicated mentoring team consists of clinician-researchers who are leaders in aging-related research with expertise in transitions of care, communication among medical providers, and intervention development. This proposal will produce preliminary data to support an extramural, R-level clinical trial that will have a substantial impact as we improve the communication between providers regarding decisions to transfer older patients.