Paramedic-coached ED Care Transitions to Help Older Adults Maintain their Health

护理人员指导的急诊护理过渡以帮助老年人保持健康

• 批准号: 9519834
• 负责人: MANISH N SHAH
• 金额: $ 55.21万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9519834
• 关键词: Accident and Emergency department; Acute; Address; Admission activity; Adverse event; Age; Ambulances; Caring; Collaborations; Communities; Comorbidity; Control Groups; Development; Effectiveness; Effectiveness of Interventions; Elderly; Emergency Care; Emergency Medicine; Emergency department visit; Ensure; Financial cost; Frequencies; Future; Government; Health; Health Care Costs; Health Personnel; Home Health Agency; Home environment; Hospital Costs; Hospitals; Impaired cognition; Instruction; Intervention; Measures; Medicine; Nurses; Outcome; Paramedical Personnel; Participant; Patients; Pharmaceutical Preparations; Population; Primary Care Physician; Process; Program Development; Psychosocial Factor; Quality of Care; Randomized; Recording of previous events; Research; Research Personnel; Resources; Services; Severities; Social Work; Social Workers; Source; Testing; Time; Transferable Skills; Universities; Validation; Vulnerable Populations; Work; anxiety symptoms; base; care coordination; cost; cost effectiveness; cost outcomes; depressive symptoms; evidence base; experience; follow-up; functional status; hospital readmission; human old age (65+); improved; innovation; intervention program; multidisciplinary; novel strategies; patient home care; patient oriented; programs; public health relevance; social; suburb; success; treatment as usual

 DESCRIPTION (provided by applicant): Older adults use the emergency department (ED) as an important source of acute care, making 20 million ED visits annually. Older adults who visit the ED do not have conditions of sufficient severity to warrant hospital admission; thus, they are treated and discharged home. Unfortunately, older adults do poorly after being discharged home from the ED, with 20% having repeat ED visits within 30 days. The ED-to-home transition has been identified as a cause for these avoidable poor outcomes, but ED-focused interventions to improve this transition have had inconclusive outcomes and have suffered from feasibility, sustainability and scalability problems. Coleman's Care Transition Intervention (CTI) has been validated to improve the hospital-to-home transition, decreasing both hospital readmissions and costs. The CTI uses coaches, usually nurses or social workers, to support patients being discharged home by transferring skills to activate patients. Applying the CTI to the ED- to-home transition is a natural extension, but it has not been evaluated in this unique and demanding setting. In this study, we will test our overall hypothesis that the community-based, paramedic-coordinated ED- to-home CTI will improve community-dwelling older adults' post-ED health outcomes and reduce costs. We will evaluate CTI process outcomes by testing if participants randomized to the CTI demonstrate better understanding of red flags that indicate a worsening of their condition, implement medication changes more frequently, and follow up with their primary care physicians more rapidly after ED discharge, as compared to the control group. We will also evaluate the effectiveness and cost-effectiveness of the CTI by testing if participants randomized to the CTI have improved Patient Activation Measure scores 30 days after discharge, have decreased frequency of ED use, and decreased health care costs within 30 days of ED discharge. Additionally, we recognize that the CTI will not eliminate all repeat ED visits. Thus, we will identify factors independently associated with repeat ED visits among CTI recipients such that future programs can ensure their needs are adequately addressed. This research will provide critical empiric evidence regarding the significant problem of poor ED-to-home transitions. By leveraging the CTI, a widely available and efficient intervention and paramedics, a highly-skilled and respected health care provider present in all communities, we will apply an innovative approach to improve older adults' health following an ED visit. Through rigorous research, we will test the effectiveness and cost- effectiveness of this approach, with a specific focus on ultimate sustainability and dissemination.

 描述(申请人提供)：老年人使用急诊科(ED)作为急诊护理的重要来源，每年有2000万急诊室就诊。前往急症室求诊的长者病情严重，不足以入院治疗，因此须接受治疗，然后出院。不幸的是，老年人出院后的表现不佳，有20%的人在30天内再次到医院就诊。教育部门到家庭的过渡已被确定为造成这些可避免的不良结果的原因，但以教育部门为重点的干预措施改善这一过渡的结果并不确定，而且存在可行性、可持续性和可扩充性问题。科尔曼的护理过渡干预(CTI)已被证实可以改善医院到家庭的过渡，减少再次住院和成本。CTI使用教练，通常是护士或社会工作者，通过传授技能来激活患者，以支持出院患者回家。将CTI应用于教育到家庭的过渡是一种自然的扩展，但在这种独特而苛刻的环境中尚未对其进行评估。在这项研究中，我们将检验我们的总体假设，即基于社区的、辅助医疗协调的ED到家庭CTI将改善社区居住的老年人在ED后的健康结果并降低成本。我们将通过测试随机参加CTI的参与者是否比对照组更好地理解表明他们的病情恶化的危险信号，更频繁地实施用药变化，以及在ED出院后更快地与他们的初级保健医生进行跟踪来评估CTI过程的结果。我们还将评估CTI的有效性和成本效益，方法是测试随机参加CTI的参与者在出院30天后是否提高了患者激活测量分数，减少了ED的使用频率，并在ED出院后30天内降低了医疗费用。此外，我们认识到，CTI不会消除所有重复就诊的ED。因此，我们将确定与CTI接受者的重复ED访问独立相关的因素，以便未来的计划可以确保他们的需求得到充分满足。这项研究将提供关键的经验性证据，说明不良的ED到家庭过渡的重大问题。通过利用CTI，一种广泛可用的高效干预和护理人员，一种在所有社区都存在的高技能和受人尊敬的医疗保健提供者，我们将应用一种创新的方法来改善急诊科就诊后老年人的健康。通过严格的研究，我们将测试这一方法的有效性和成本效益，并特别关注最终的可持续性和传播。