PCplanner: operationalizing needs-focused palliative care for older adults in intensive

以重症监护病房(ICU)为基础的姑息治疗的质量是高度可变的，特别是对200万人来说 老年人每年都会住进重症监护室。然而，通过 有效地提供以患者为中心、以需求为目标的姑息治疗具有挑战性，因为后勤和 技术壁垒。为了解决老年ICU患者的这些护理提供障碍，我们开发了 一个名为PCplanner(姑息治疗计划)的移动应用平台。PCplanner自动识别 通过直接捕获数据对高危患者(例如，痴呆症、健康状况下降、功能不良)进行分析 从电子健康记录(EHR)系统，培养家庭对支持性信息的参与 以及一个数字系统，用于自我报告实际需求，并促进向那些高度依赖的人提供护理 通过协调ICU团队和姑息治疗专家之间的合作，减轻需要的负担。在试行中 与标准的姑息治疗对照相比，干预减少了未得到满足的需求，心理上 痛苦、住院时间和增加的目标一致的护理、沟通和临终关怀利用。 虽然这些数据令人信服，但需要对PCplanner进行疗效评估。因此，我们 建议招募250名患者，270名家庭照顾者，215名医生和护士来自学术和 一个为期5年的项目中的社区设置有3个目标：(1)优化完全实现的PCplanner平台的 老年人的可用性，(2)测试PCPlanner增强的协作式姑息治疗与 随机临床试验(RCT)中的常规护理，随访3个月，以及(3)探索家庭照顾者 以及临床医生使用混合方法了解干预机制以及 不同案例背景下的实施障碍。我们假设，与通常的护理相比， PCplanner将减少家庭照顾者未得到满足的需求和心理困扰，增加频率 改善老年患者的治疗目标，减少住院天数。 PCplanner代表了一种潜在的变革性、改变范式的方法来提供可扩展的 为老年人提供基于ICU的个性化姑息治疗：它充当可复制的基础设施 协作护理模式，提供最先进的技术构建，支持实时直接数据 从任何医院的EHR捕获(即互操作性)，并自动测量患者-/ 以家庭为中心的成果和质量指标--这些都是当前做法所缺乏的领域。这 理论上扎根的项目的众多技术和概念创新解决了研究 NIH(姑息治疗优先工作组)、国家协调员办公室详细说明的优先事项 (连接国家健康和关怀路线图)和国家医学研究院(VITAL 卫生保健服务倡议的指导)。我们能够成功地进行这项研究是因为我们的 多学科团队的专业知识和我们机构及其临床医生的热情支持。

The quality of intensive care unit (ICU)-based palliative care is highly variable, particularly for the 2 million older adults admitted annually to ICUs. However, improving care quality on a broad scale with the efficient delivery of patient-centered, need-targeted palliative care is challenging because of logistical and technological barriers. To address these care delivery barriers among older ICU patients, we developed a mobile app platform called PCplanner (Palliative Care planner). PCplanner automates the identification of high-risk patients (e.g., dementia, declining health status, poor functioning) by directly capturing data from electronic health record (EHR) systems, cultivates family engagement with supportive information and a digital system for self-report of actual needs, and facilitates the delivery of care to those with a high burden of need by coordinating collaboration between ICU teams and palliative care specialists. In pilot comparison to a standard palliative care control, the intervention reduced unmet needs, psychological distress, and length of stay and increased goal concordant care, communication, and hospice utilization. While these data are compelling, an efficacy evaluation of PCplanner is needed. Therefore, we propose to enroll 250 patients, 270 family caregivers, and 215 physicians and nurses from academic and community settings in a 5-year project with 3 aims: (1) Optimize the fully realized PCplanner platform’s usability for older adults, (2) Test the efficacy of PCplanner-augmented collaborative palliative care vs usual care in a randomized clinical trial (RCT) with 3-month follow up, and (3) Explore family caregiver and clinician experiences using mixed methods to understand intervention mechanisms as well as implementation barriers within diverse case contexts. We hypothesize that compared to usual care, PCplanner will reduce family caregivers’ unmet needs and psychological distress, increase the frequency of goal concordant treatment among older adult patients, and reduce hospital length of stay. PCplanner represents a potentially transformative, paradigm-changing approach to delivering scalable personalized ICU-based palliative care for older adults: it acts as infrastructure for a replicable collaborative care model, provides a state of the art technological build that enables real-time direct data capture from any hospital’s EHR (i.e., interoperability), and automates the measurement of patient- / family-centered outcomes and quality indicators—all areas that are lacking in current practice. This theoretically grounded project’s numerous technological and conceptual innovations address research priorities detailed by the NIH (Palliative Care Priorities Workgroup), the Office of the National Coordinator (Connecting Health and Care for the Nation Roadmap), and the National Academy of Medicine (Vital Directions for Health Care Services initiative). We can perform this research successfully because of our multidisciplinary team’s expertise and the enthusiastic support of our institution and its clinicians.