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

为痴呆症患者(PWD)提供适当的护理 医院和卫生系统面临的挑战。医院经常是令人迷失方向的环境， 尤其是对于残疾人士来说，他们在表达和沟通方面可能存在困难 医生、护士或其他医院提供者的近期需求或长期目标。拥有 电子健康档案(EHR)中此类认知障碍患者的生活故事 可能为改善以人为中心的护理提供机会，这是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关怀 团队要看到这个人超越了他们的认知障碍，并了解这个人目前的 行动、信念和价值观。这项第一阶段研究的目的是测试可行性和 改编Memory的可接受性Well的人生故事解决方案，最初是为长期设计的 护理环境，在急性护理医院的环境中，简短的病人生活故事将是 并入医院电子病历。为了实现这一目标，与加州大学合作 加州旧金山老年人急性护理(ACE)单位，本研究的目标1将采取 迭代、参与式设计方法，包括对患者、家属的访谈和调查 成员和医院提供者调整Memory Well的人生故事采访流程和 关于急诊医院环境中的PWD的问卷调查。目标2将采用类似的迭代， 参与式设计方法，共同设计用于集成的系统、故事格式和后勤 急性护理环境下电子病历内的生活故事，以及BEST的初步调查 将这些故事传递到急性发作后环境的做法。接下来，在Aim 3，25层楼 将为获准进入加州大学旧金山分校ACE单元的PWD创建。在实施这些措施之后 根据AIMS 1和AIMS 2中建立的协议，符合条件的患者、家属、 医院提供者将接受采访和调查，了解他们的生活经历 以确定其在ACE环境中纳入的可接受性和可行性。目标 3还将包括对加州大学旧金山分校EHR的使用数据进行分析，以提供 在不同类型的医院提供商用户(医生、护士、病人护理)之间提供生活体验 助理、社会工作者、牧师和案件管理人员)。为未来奠定基础 随机对照试验(RCT)，AIM 3参与者也将被要求提供关于 他们认为在以下情况下最合适和最相关的潜在规模和结果衡量标准 在急诊护理医院环境中使用生活故事。

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.