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 尽管大多数美国人希望在家里和平地死亡，但许多美国人都死于痛苦和医院。四分之一 Medicare美元（超过1000亿美元）用于患者的最后一年，许多是癌症患者。在 简而 和垂死的患者。有效的姑息治疗对垂死和严重患者的患者满足了这一需求。此外， 美国医疗保健质量的提高并没有使低收入和少数族裔患者同样受益， 谁仍然更有可能拥有临床各个领域的医疗保健经历和结果 设置和疾病。患者导航器计划，其中外行健康工作者帮助患者导航 系统，已经显示出有望提高特定患者人群中护理质量的希望，但不是 由于成本和疾病特定的内容而广泛实施。一个成本较低，更广泛适用的计划 对于更大的人群，有可能提高质量和结果。长期目标的 K08候选人Fabian Johnston，医学博士，MHS，是为了提高医疗保健质量，经验和成果 通过开发和评估面向系统的，家庭参与的干预措施，用于服务不足的患者 潜力广泛的人口影响。该目标与AHRQ，NCI和PCORI一致， 改善护理模型的实施，利用利益相关者参与，减少分配和 改善了姑息治疗的使用。 为了实现他的目标，约翰斯顿博士将接受教学和专家培训以提高知识 和四个领域的技能：（1）患者导航； （2）参与者参与的计划开发和研究； （3） 比较有效性和利益相关者的参与； （4）传播和实施科学。 约翰斯顿博士已经召集了一个心态团队，具有医疗保健质量研究专业知识， 差异，患者导航，姑息治疗，利益相关者参与和参与参与的研究 确保完成拟议的研究和培训以及成功过渡到独立性。博士 约翰斯顿提出，以他的培训目标为基础的三个顺序创新项目。这些项目将 为非洲量身定制的导航计划的开发和试点评估做出贡献 美国先进的固体器官恶性肿瘤患者，针对预先护理计划，疼痛 管理和临终关怀转诊。具体目的是：（1）与主要利益相关者合作以开发一个 有针对性的患者导航计划； （2）试点测试文化量身定制的患者导航干预措施； （3） 通过先锋评估的患者导航的可行性，可接受性，成本和影响 非裔美国人晚期恶性肿瘤患者的随机试验。 该提议在其中是新颖的 将患者导航应用于需要姑息治疗的患者；并使用利益相关者参与 为了帮助将导航改编成黑发，廉价的干预措施以促进传播。