Feasibility and acceptability of introducing person-centered narratives in an acute care setting for people with Alzheimer's and Dementia

在阿尔茨海默病和痴呆症患者的紧急护理环境中引入以人为本的叙述的可行性和可接受性

• 批准号: 10325290
• 负责人: Jay Newton-Small
• 金额: $ 50万
• 依托单位: MEMORYWELL LLC
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10325290
• 关键词: Acute; Alzheimer' s Disease; Alzheimer' s disease related dementia; Belief; Biography; California; Caring; Case Manager; Clinical Data; Collection; Communication; Data; Dementia; Diagnosis; Elderly; Electronic Health Record; Environment; Evaluation; Family member; Feedback; Foundations; Future; Goals; Grant; Health Personnel; Health system; Healthcare Systems; Hospital Costs; Hospitals; Impaired cognition; Interview; Investigation; Job Satisfaction; Length of Stay; Life; Life Experience; Location; Logistics; Loneliness; Long-Term Care; Long-Term Care for Elderly; Measures; Notification; Nurses; Outcome; Outcome Measure; Participant; Patient Care; Patients; Persons; Phase; Physicians; Process; Production; Protocols documentation; Provider; Quality of life; Questionnaires; Randomized Controlled Trials; Recommendation; San Francisco; Series; Social Workers; Structure; Surveys; System; Techniques; Testing; Time; United States; Universities; acceptability and feasibility; acute care; base; burnout; clinical care; cognitive disability; dementia care; design; experience; feasibility testing; improved; inpatient service; person centered; phase 1 study; prototype; readmission rates; satisfaction; standard of care

Providing appropriate care for persons with dementia (PWD) poses a significant challenge for hospitals and health systems. Hospitals are often disorienting environments, particularly for PWD who can have difficulty expressing themselves and communicating their immediate needs or longer-term goals to physicians, nurses or other hospital providers. Having the life stories of patients with such cognitive impairments in the electronic health record (EHR) may provide an opportunity to improve person-centered care, the foundation of the Alzheimer’s Association’s Dementia Care Practice Recommendations. Brief life stories can allow the care team to see the person beyond their cognitive disabilities and understand the person’s current actions, beliefs, and values. The purpose of this Phase I study is to test the feasibility and acceptability of adapting MemoryWell’s life story solution, originally designed for long-term care settings, in an acute care hospital setting in which brief patient life stories would be incorporated into the hospital EHR. To accomplish this, in partnership with University of California San Francisco Acute Care for Elders (ACE) unit, Aim 1 of this study will take an iterative, participatory-design approach including interviews and surveys of patients, family members, and hospital providers to adapt MemoryWell’s life story interview process and questionnaire for PWD in the acute care hospital setting. Aim 2 will employ a similar iterative, participatory-design approach to co-design a system, story format, and logistics for integrating life stories within the EHR in the acute care setting, as well as a preliminary investigation of best practices for transmitting these stories to post-acute settings. Following this, in Aim 3, 25 stories will be created for PWD admitted to the UCSF ACE unit. Following the implementation of these stories according to protocols established in Aims 1 and 2, eligible patients, family members, and hospital providers will be interviewed and surveyed about their experiences with the life stories to establish the acceptability and feasibility of their incorporation in the ACE setting. Aim 3 will also include analysis of usage data from the UCSF EHR to provide quantitative metrics of life story access across different types of hospital provider users (physicians, nurses, patient care assistants, social workers, chaplains and case managers). To lay the groundwork for a future randomized controlled trial (RCT), Aim 3 participants will also be asked to provide input on potential scales and outcome measures they believe are most appropriate and relevant when using life stories in the acute care hospital setting.

为痴呆症患者提供适当的护理， 对医院和卫生系统的挑战。医院往往是令人迷失方向的环境， 特别是对于残疾人来说，他们很难表达自己和交流他们的想法。 医生、护士或其他医院提供者的即时需求或长期目标。具有 电子健康记录（EHR）中有此类认知障碍的患者的生活故事 可能提供一个机会，以改善以人为本的护理，阿尔茨海默氏症的基础， 协会的痴呆症护理实践建议。简短的生活故事可以让护理 团队看到的人超越他们的认知障碍，并了解人的电流 行为、信仰和价值观。第一阶段研究的目的是测试可行性， 改编MemoryWell的生活故事解决方案的可接受性，最初是为长期设计的 护理环境，在急性护理医院环境中，简短的患者生活故事将 纳入医院EHR。为了实现这一目标，在与大学的合作， 加州旧金山弗朗西斯科老年人急性护理（ACE）单位，本研究的目标1将采取 迭代的参与式设计方法，包括对患者、家属 成员和医院提供者，以适应MemoryWell的生活故事采访过程， 急性护理医院环境中PWD的问卷调查。目标2将采用类似的迭代， 参与式设计方法，共同设计一个系统，故事格式，和物流整合 生活中的EHR在急性护理设置的故事，以及初步调查的最佳 将这些故事传播到急性后环境的做法。在此之后，在目标3中，25个故事 将创建PWD承认UCSF ACE单位。在实施这些措施后， 根据目标1和2中确立的方案，合格患者，家庭成员， 和医院提供者将接受采访和调查，了解他们的生活经验， 故事，以建立其纳入ACE设置的可接受性和可行性。目的 3还将包括分析UCSF EHR的使用数据，以提供 不同类型的医院提供者用户（医生、护士、患者护理）之间的生活故事访问 助理、社会工作者、牧师和个案经理）。为未来打下基础 随机对照试验（RCT），目标3受试者还将被要求提供以下信息 他们认为最合适和最相关的潜在量表和结局指标， 在急症护理医院中使用生活故事。