Promoting Early Utilization of Palliative Care for African Americans Using Culturally Informed Patient Navigation

使用文化知情的患者导航促进非裔美国人早期使用姑息治疗

• 批准号: 9753149
• 负责人: Fabian M Johnston
• 金额: $ 14.77万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-09 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9753149
• 关键词: Promoting; Early; Utilization; Palliative; Care

Project Summary Although most Americans wish to die peacefully at home, many die in pain and in the hospital. A quarter of Medicare dollars – over $100 billion - is spent for patients in their last year of life many are cancer patients. In brief, there is a desperate need for higher quality, more affordable, better patient-centered care for severely ill and dying patients. Effective palliative care for dying and severely ill patients meets this need. Additionally, improvements in the quality of US health care have not equally benefitted low income and minority patients, who remain more likely to have worse health care experiences and outcomes across the spectrum of clinical settings and diseases. Patient navigator programs, in which lay health workers help patients navigate the system, have shown promise for improving quality of care among specific patient populations, but are not widely implemented due to cost and disease-specific content. A less costly, more broadly applicable program would have the potential to improve quality and outcomes for a larger population. The long-term objective of the K08 candidate, Fabian Johnston, MD, MHS, is to improve health care quality, experiences and outcomes for underserved patients by developing and evaluating systems-oriented, family- engaged interventions with potential for broad population impact. This goal is consistent withAHRQ, NCI, and PCORI, priority areas of improving implementation of models of care, utilization of stakeholder engagement, reduction of disparities and improved use of palliative care. To achieve his objective, Dr. Johnston will undertake didactic and experiential training to improve knowledge and skills in four areas: (1) patient navigation; (2) participant-engaged program development and research; (3) comparative effectiveness and stakeholder engagement; and (4) dissemination and implementation science. Dr. Johnston has assembled a mentorship team with expertise in health care quality research, disparities, patient navigation, palliative care, stakeholder engagement and participant-engaged research, to ensure completion of the proposed research and training and successful transition to independence. Dr. Johnston proposes three sequential, innovative projects that build upon his training goals. These projects will contribute to the development and pilot evaluation of a culturally tailored navigation program for African American patients with advanced solid organ malignancies, targeted to the advance care planning, pain management, and hospice referral. The specific aims are: (1) to collaborate with key stakeholders to develop a targeted patient navigation program; (2) to pilot test the culturally tailored patient navigator intervention; and (3) toassess the feasibility, acceptability, cost, and impact of patient navigation as assessed by a vanguard randomized trial among African American patients with advanced malignancies. This proposal is novel in its application of patient navigation to patients in need of palliative care; and in its use of stakeholder engagement to aid in adaptation of navigation into a briefer, less costly intervention to facilitate dissemination.

项目摘要 虽然大多数美国人希望在家中平静地死去，但许多人在医院里痛苦地死去。四分之一 医疗保险的资金超过1000亿美元，用于病人生命的最后一年，其中许多是癌症病人。在 简而言之，迫切需要更高质量，更负担得起，更好的以患者为中心的重症护理 和垂死的病人为垂死和重病患者提供有效的姑息治疗满足了这一需求。此外，本发明还 美国医疗保健质量的改善并没有同样地使低收入和少数民族患者受益， 他们在临床治疗的各个方面仍然更有可能有更糟糕的医疗保健经历和结果， 环境和疾病。患者导航程序，其中非专业卫生工作者帮助患者导航 系统，已经显示出改善特定患者群体护理质量的前景，但 由于成本和疾病特异性内容而被广泛实施。成本更低、适用范围更广的计划 将有可能为更多的人提高质量和成果。的长期目标 K 08候选人Fabian约翰斯顿，医学博士，MHS，是为了提高医疗保健质量，经验和结果 通过开发和评估系统导向的，家庭参与的干预措施， 潜在的广泛人口影响。这一目标与AHRQ、NCI和PCORI的优先领域一致， 改善护理模式的实施，利用利益攸关方的参与，减少差异， 改善姑息治疗的使用。 为了实现他的目标，约翰斯顿博士将进行教学和经验培训，以提高知识 四个领域的技能：（1）患者导航;（2）参与者参与的项目开发和研究;（3） 相对有效性和利益攸关方的参与;（4）传播和实施科学。 博士约翰斯顿组建了一个具有医疗质量研究专业知识的导师团队， 差异，患者导航，姑息治疗，利益相关者参与和参与者参与的研究， 确保完成拟议的研究和培训，并成功过渡到独立。博士 约翰斯顿提出了三个连续的，创新的项目，建立在他的培训目标。这些项目将 为非洲文化定制的导航计划的开发和试点评估做出贡献 美国晚期实体器官恶性肿瘤患者，有针对性地提前制定护理计划， 管理和临终关怀转诊。具体目标是：（1）与主要利益相关者合作， 有针对性的患者导航计划;（2）对文化定制的患者导航干预进行试点测试;以及（3） 评估先锋评估的患者导航的可行性、可接受性、成本和影响 在患有晚期恶性肿瘤的非裔美国人患者中进行的随机试验。 这一建议是新颖的， 将患者导航应用于需要姑息治疗的患者;以及利益相关者参与的使用 帮助将导航调整为更简短、成本更低的干预措施，以促进传播。