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

PCplanner：为重症监护室的老年人实施以需求为中心的姑息治疗

• 批准号: 10388340
• 负责人: Christopher Ethan Cox
• 金额: $ 56.54万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10388340
• 关键词: Academy; Address; Aging; Area; Caregivers; Caring; Cessation of life; Characteristics; Clinical; Clinical Trials; Collaborations; Communication; Communities; Computerized Medical Record; Data; Decision Making; Dementia; Dissemination and Implementation; Elderly; Electronic Health Record; Enrollment; Environment; Family; Family Caregiver; Feedback; Frequencies; Future; Goals; Health; Health Status; Health system; Healthcare; Hospitals; Infrastructure; Institution; Intensive Care Units; Intervention; Interview; Length of Stay; Life; Logistics; Measurement; Medical; Medical center; Medicine; Methods; Modeling; Nurses; Outcome; Palliative Care; Participant; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Physicians; Process; Public Health Informatics; Quality Indicator; Quality of Care; Randomized; Randomized Clinical Trials; Reporting; Research; Research Personnel; Research Priority; Service delivery model; Site; Specialist; Structure; Surgical Intensive Care; Symptoms; System; Technology; Testing; Time; Treatment Efficacy; United States; United States National Institutes of Health; Work; base; care coordination; care delivery; care providers; clinical care; collaborative care; community setting; connected care; digital; efficacy evaluation; efficacy testing; electronic data; experience; follow-up; future implementation; health care service; high risk; hospice environment; implementation barriers; implementation context; improved; improved outcome; innovation; insight; interoperability; medical specialties; mobile application; multidisciplinary; older patient; patient oriented; prototype; psychological distress; secondary outcome; shift work; treatment as usual; usability

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.

重症监护病房 (ICU) 姑息治疗的质量差异很大，特别是对于 200 万人而言 每年都有老年人入住 ICU。然而，随着 由于后勤和资源问题，有效提供以患者为中心、以需求为目标的姑息治疗具有挑战性。 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（姑息治疗规划师）的移动应用程序平台。 PCplanner 自动识别 通过直接捕获数据来识别高风险患者（例如痴呆症、健康状况下降、功能不良） 来自电子健康记录 (EHR) 系统，通过支持性信息培养家庭参与度 以及用于自我报告实际需求的数字系统，并促进向高收入人群提供护理 通过协调 ICU 团队和姑息治疗专家之间的合作来减轻需求负担。试点中 与标准姑息治疗对照相比，干预减少了未满足的需求、心理 痛苦和住院时间以及增加目标一致护理、沟通和临终关怀的利用。 虽然这些数据令人信服，但仍需要对 PCplanner 进行功效评估。因此，我们 建议招募 250 名患者、270 名家庭护理人员以及 215 名来自学术界和学术界的医生和护士。 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 增强协作姑息治疗与 随机临床试验 (RCT) 中的常规护理，并进行 3 个月的随访，以及 (3) 探索家庭护理人员 和临床医生使用混合方法的经验来了解干预机制以及 不同案例背景下的实施障碍。我们假设与常规护理相比， PCplanner将减少家庭照顾者未满足的需求和心理困扰，增加频率 老年患者的目标一致治疗，并减少住院时间。 PCplanner 代表了一种潜在的变革性、范式改变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 协作护理模型，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——所有这些都是当前实践所缺乏的。这 具有理论基础的项目的众多技术和概念创新致力于研究 国家协调员办公室 NIH（姑息治疗优先工作组）详细说明的优先事项 （连接国家健康与护理路线图）和国家医学院（重要 医疗保健服务倡议方向）。我们能够成功地进行这项研究是因为我们 多学科团队的专业知识以及我们机构及其临床医生的热情支持。