GAPcare: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare：老年急性病

• 批准号: 9364690
• 负责人: Elizabeth Goldberg
• 金额: $ 12.08万
• 依托单位: RHODE ISLAND HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-15 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9364690
• 关键词: Accident and Emergency department; Acute; Address; Administrator; Admission activity; Adult; Adverse drug event; Calendar; Caregivers; Caring; Collaborations; Communities; Continuity of Patient Care; Data; Discharge Plannings; Elderly; Eligibility Determination; Emergency Care; Emergency Department Physician; Emergency Department evaluation; Emergency Department patient; Emergency Department-based Intervention; Emergency department visit; Enrollment; Evaluation; Exercise; Failure; Fall prevention; Feedback; Goals; Health Care Costs; Health Care Visit; Home environment; Hospitals; Injury; Intervention; Investigation; K-Series Research Career Programs; Length of Stay; Location; Mission; Modeling; Morbidity - disease rate; National Institute on Aging; Occupational Therapy; Older Population; Outpatients; Participant; Patients; Pharmacists; Physical therapy; Physicians; Preventive Intervention; Public Health; Quality of life; Randomized; Recruitment Activity; Recurrence; Research; Risk Factors; Sample Size; Specialist; Spottings; Standardization; Suggestion; Testing; Time; Training; United States National Institutes of Health; arm; base; career development; collaborative care; design; falls; follow-up; health care service utilization; high risk; human old age (65+); improved; improved functioning; improved outcome; innovation; mortality; multidisciplinary; physical therapist; prevent; programs; satisfaction; tool; treatment as usual; treatment planning

PROJECT SUMMARY Falls are the leading injury-related cause of Emergency Department (ED) visits in older adults and are both preventable and predictable, but the typical ED evaluation focuses on an injury assessment only. GAPcare, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, is an early stage investigation for preventing recurrent falls in older adults that present to the ED. Participants in this study will be adults ( 65 years old) who had a fall and present to the ED for care. We will randomly assign participants to an intervention or usual care arm. In the intervention arm physical therapists (PTs), pharmacists, and the ED physician collaborate to identify reasons the patient fell and address any identified risk factors. Seniors will return home with a standardized checklist containing details of their assessment and an exercise plan. These participants are referred to the same PT group for outpatient physical or occupational therapy, to provide continuity of care. Participants in the usual care arm receive care as provided by the ED physician only. Our long-term goal is to prevent the early morbidity and mortality of older adults who present to the ED after a fall. The overall objective of this investigation is to gather preliminary data on the feasibility, initial efficacy, and to solicit feedback on the GAPcare intervention to further refine our approach for the subsequent study. The central hypothesis is that GAPcare will lead to fewer falls by eliminating risk factors and giving patients tools for improving function. The rationale is that the ED visit is a teachable moment, in which patients and caregivers are engaged and collaboration of specialists is possible. Older adults have many barriers to accessing timely and comprehensive fall evaluations after discharge. We will pursue the following specific aims to test and further refine the GAPcare intervention: (1) Examine the feasibility of recruitment and retention of eligible patients into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention in reducing subsequent falls and healthcare utilization at 6 months. This will inform the effect size and sample size calculations for the subsequent study, and (3) solicit feedback from physicians and patients on their satisfaction with the GAPcare intervention. This investigation is expected to have two major contributions: 1. We will gather information on the feasibility, initial efficacy, and solicit feedback on the GAPcare intervention, which will help refine our approach for the subsequent study and 2. Dr. Goldberg will receive the training and preliminary data to submit a larger study as a K award to the National Institute on Aging. The public health significance of this intervention is immense as falls are the leading cause of fatal and non-fatal injury in older adults and no model of collaborative care exists to direct ED administrators and other stakeholders to reduce the occurrence of subsequent falls. This proposal is highly innovative because unlike other community-based programs it targets the most high-risk seniors in the ED during the period immediately after a fall when patients are most vulnerable for repeat falls and highly engaged in their care.

项目摘要 福尔斯是老年人急诊（艾德）就诊的主要伤害相关原因， 但是典型的艾德评估只关注损伤评估。GAPcare，The 老年急性和急性后护理协调计划，预防急诊科跌倒， 是一项早期研究，旨在预防向ED提出的老年人复发性福尔斯。参与者 本研究中的受试者为跌倒并到艾德接受治疗的成年人（65岁）。我们将随机 将参与者分配到干预组或常规护理组。在干预组中，物理治疗师（PT）， 药剂师和艾德医生合作，以确定患者跌倒的原因，并解决任何已确定的 危险因素老年人将带着一份标准化的清单回家，清单上有他们评估的细节， 锻炼计划这些受试者被转介到同一PT组进行门诊体检或职业体检。 治疗，以提供连续性的护理。常规护理组的受试者接受由艾德提供的护理 只有医生。我们的长期目标是预防老年人的早期发病和死亡， 送去了艾德医院本次调查的总体目标是收集可行性的初步数据， 初步疗效，并征求反馈意见的GAP护理干预，以进一步完善我们的方法， 后续研究。核心假设是，通过消除风险因素，GAP护理将减少福尔斯， 为患者提供改善功能的工具。其理由是，艾德访问是一个可教的时刻，其中 患者和护理人员都参与进来，专家之间的合作也成为可能。老年人有许多 出院后及时获得全面跌倒评估的障碍。我们将继续努力 测试和进一步完善GAP护理干预措施的具体目标：（1）审查招募的可行性， 保留合格患者进入GAP护理干预，（2）确定GAP护理的初始疗效 在6个月时进行干预以减少随后的福尔斯和医疗保健利用。这将告知效应大小 以及随后研究的样本量计算，以及（3）征求医生和患者的反馈， 他们对GAPcare干预的满意度。此次调查预计将有两大 贡献：1.我们将收集有关可行性、初步疗效的信息，并征求对 GAPcare干预，这将有助于完善我们的方法，为随后的研究和2。金伯格医生会 接受培训和初步数据，以提交一个更大的研究，作为K奖的国家研究所 衰老这种干预的公共卫生意义是巨大的，因为福尔斯是致命的主要原因， 老年人中的非致命性损伤，并且不存在指导艾德管理人员的协作护理模式， 其他利益相关者，以减少后续福尔斯的发生。这一建议极具创新性，因为 与其他以社区为基础的项目不同，它针对的是艾德在此期间最高危的老年人 在跌倒后，当患者最容易重复福尔斯跌倒并高度参与护理时，立即进行治疗。