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Reaching the Most Vulnerable: A Novel Model of Care in Advanced Parkinson's Disease

帮助最弱势群体：晚期帕金森病的新型护理模式

基本信息

批准号：
10226958
负责人：
Jori Erin Fleisher
金额：
$ 18.34万
依托单位：
RUSH UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-25 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10226958
关键词：
Address Alzheimer&apos s Disease Anxiety Belief Caregiver research Caregiver support Caregivers Caring Chronic Clinical Investigator Clinical Research Clinical Services Comparative Effectiveness Research Cost effectiveness research Data Deterioration Disabled Persons Disease Dissemination and Implementation Elderly Enrollment Ensure Fellowship Five-Year Plans Foundations Future Geriatrics Goals Health Health Care Costs Health Services Accessibility Health Services Research Healthcare Home Home visitation Hospitals Improve Access Individual Institution Institutionalization Intervention Master of Science Measures Mental Depression Mentorship Modeling Morbidity - disease rate Movement Disorders National Institute of Neurological Disorders and Stroke Nerve Degeneration Neurologic Neurology New York Outcome Palliative Care Parkinson Disease Patient-Focused Outcomes Patients Pennsylvania Pharmaceutical Preparations Population Prospective Studies Quality of Care Quality of life Questionnaires Randomized Reporting Research Research Personnel Science Severities Source Structure Testing Training Treatment Efficacy Universities Ursidae Family Visit aging in place barrier to care base budget impact career career development caregiver strain clinical epidemiology cohort comparative cost effectiveness cost cost effectiveness design disability disabling symptom effective therapy efficacy testing experience follow-up health care service utilization health literacy improved improved outcome in-home care indexing longitudinal database medical schools meetings mortality nervous system disorder novel patient home care patient oriented research peer coaching population health professor program costs programs research and development self-directed learning skills telehealth training opportunity treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT As Parkinson's Disease (PD) progresses, the symptoms of this debilitating and costly condition increase in number and severity, quality of life declines, and caregiver strain rises, resulting in 100-200,000 US patients becoming homebound. This population loses access to care despite overwhelming need. Evidence supports interdisciplinary and home-based models of care in other elderly cohorts, and the use of telehealth in earlier stages of PD; however, none of these have been formally tested in advanced PD. The long-term goals of this K23 are 1) to develop the candidate into a leader in the fields of movement disorders and health services research, and 2) to develop, test, and disseminate models of care and related interventions to improve access to care, quality of care, and quality of life for patients with advanced PD and their caregivers. The aims of this project are 1) to test the efficacy of an interdisciplinary home visit program for patients with advanced PD on patient quality of life and caregiver strain when compared with usual care; 2) to compare the effects of home visits with and without caregiver peer mentoring on caregiver health; and 3) to conduct a budget impact analysis of the model. We will prospectively study 60 patient-caregiver pairs matched with subjects receiving usual care within the National Parkinson Foundation Parkinson's Outcome Project (POP); we will enroll 36 experienced past caregivers as peer mentors. The K23 candidate is an Assistant Professor of Neurology and Population Health at New York University School of Medicine, and completed a movement disorders fellowship and NINDS T32-supported Master's of Science in Clinical Epidemiology at the University of Pennsylvania. She has conducted clinical and health services research in geriatrics, neurology, and PD, identifying health literacy and medication beliefs as barriers to care. She has demonstrated the feasibility of a pilot interdisciplinary home visit program for homebound individuals with PD. The candidate is committed to a career in patient-oriented research and proposes an comprehensive five-year plan of mentorship, formal training, self-directed learning, and research. She will develop expertise and skills in: 1) Implementation and dissemination science; 2) Comparative and cost effectiveness research; and 3) Palliative care skills and research. The results of this K23 will inform future R01 applications that will test the efficacy and cost effectiveness of this model for advanced PD in other settings, and adapt this model to other chronic neurologic conditions. By identifying, testing, and disseminating effective therapies and models of care for this previously understudied population, we can minimize morbidity and unnecessary healthcare utilization. Dr. Fleisher's mentorship team includes expertise in PD, implementation and dissemination of interdisciplinary care models, telehealth, cost effectiveness, and the POP. The outstanding institutional support, and proposed training, career development, and research plans will ensure Dr. Fleisher's successful transition to an independent clinical investigator dedicated to improving the health outcomes of patients with advanced Parkinson's Disease and other neurodegenerative conditions.

项目总结/摘要随着帕金森病（PD）的进展，这种使人衰弱和昂贵的疾病的症状在患者中增加。数量和严重程度，生活质量下降，护理人员压力上升，导致100- 200，000名美国患者成为居家尽管需求巨大，但这一人群仍无法获得护理。证据支持在其他老年人群体中采用跨学科和以家庭为基础的护理模式，然而，这些都没有在晚期PD中进行正式测试。长期目标是 K23是1）发展候选人成为运动障碍和健康服务领域的领导者研究，2）制定、测试和传播护理模式和相关干预措施，以改善获得服务的机会护理、护理质量和晚期PD患者及其护理者的生活质量。其目的是项目是1）测试跨学科家访计划对晚期PD患者的疗效，与常规护理相比，患者的生活质量和护理人员的压力; 2）比较家庭护理的效果在有和没有照顾者同行指导的情况下进行关于照顾者健康的访问;以及3）进行预算影响模型的分析。我们将前瞻性研究60对患者-护理人员配对，在国家帕金森基金会帕金森结果项目（POP）中的常规护理;我们将招募36名有经验的过去照顾者作为同伴导师。K23候选人是神经病学助理教授，纽约大学医学院人口健康专业，并完成了运动障碍奖学金和NINDS T32支持的宾夕法尼亚大学临床流行病学硕士学位。她在老年病学、神经学和PD方面进行了临床和卫生服务研究，确定了健康素养和药物信仰作为护理的障碍。她已经证明了试点跨学科之家的可行性为居家PD患者提供的访问计划。候选人致力于以病人为导向的职业生涯研究并提出一个全面的五年计划，包括导师制、正规培训、自主学习、与研究她将发展以下方面的专业知识和技能：1）实施和传播科学; 2）比较和成本效益研究;和3）姑息治疗技能和研究。K23的结果将告知未来的R 01应用程序，将测试这种模式的效率和成本效益，以先进的其他环境中的PD，并使该模型适应其他慢性神经系统疾病。通过识别、测试和传播有效的治疗和护理模式，为这一以前研究不足的人群，我们可以最大限度地减少发病率和不必要的医疗保健使用。Fleurs博士的导师团队包括以下方面的专业知识： PD，跨学科护理模式的实施和传播，远程医疗，成本效益，以及爸优秀的机构支持，以及拟议的培训，职业发展和研究计划将确保Fleurs博士成功过渡到一个独立的临床研究者，致力于改善晚期帕金森病和其他神经退行性疾病患者的健康结果。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease.

DOI：
10.1016/j.parkreldis.2022.07.017
发表时间：
2022-09
期刊：
PARKINSONISM & RELATED DISORDERS
影响因子：
4.1
作者：
Fleisher, Jori E.;Hess, Serena P.;Klostermann, Ellen C.;Lee, Jeanette;Myrick, Erica;Mitchem, Daniela;Niemet, Claire;Woo, Katheryn;Sennott, Brianna J.;Sanghvi, Maya;Witek, Natalie;Beck, James C.;Wilkinson, Jayne R.;Ouyang, Bichun;Hall, Deborah A.;Chodosh, Joshua
通讯作者：
Chodosh, Joshua

Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic.

DOI：
10.3233/jpd-202156
发表时间：
2020
期刊：
Journal of Parkinson's disease
影响因子：
0
作者：
Sennott B;Woo K;Hess S;Mitchem D;Klostermann EC;Myrick E;Anderson S;Savica R;Fleisher JE
通讯作者：
Fleisher JE

Anatomy, Physiology, and Clinical Syndromes of the Basal Ganglia: A Brief Review.

DOI：
10.1016/j.spen.2017.12.005
发表时间：
2018-04
期刊：
Seminars in pediatric neurology
影响因子：
2.7
作者：
Fazl A;Fleisher J
通讯作者：
Fleisher J

The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home.

DOI：
10.1186/s12909-022-03430-7
发表时间：
2022-06-28
期刊：
BMC MEDICAL EDUCATION
影响因子：
3.6
作者：
Hess, Serena P.;Levin, Melissa;Akram, Faizan;Woo, Katheryn;Andersen, Lauren;Trenkle, Kristie;Brown, Patricia;Ouyang, Bichun;Fleisher, Jori E.
通讯作者：
Fleisher, Jori E.

Family Caregiver Comorbidities in Lewy Body Dementia Versus Alzheimer Disease and Associated Disorders.