I CAN DO Surgical ACP (Improving Completion, Accuracy, and Dissemination Of Surgical Advanced Care Planning) Trial
I CAN DO Surgical ACP(提高外科高级护理计划的完成度、准确性和传播)试验
基本信息
- 批准号:10649843
- 负责人:
- 金额:$ 69.88万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-08-01 至 2024-07-31
- 项目状态:已结题
- 来源:
- 关键词:AdoptionAdvance Care PlanningAdvance DirectivesArticulationBiometryCaregiversCaringCessation of lifeClinicClinicalClinical TrialsCollaborationsColonoscopyCommunicationComplexData ScienceDecision MakingDedicationsDocumentationEffectivenessElderlyElective Surgical ProceduresElectronic Health RecordEnsureEvaluationFamiliarityFoundationsGeographyGeriatricsGoalsGuidelinesHealthHealth ServicesHealth StatusHealth behaviorHealth systemHealthcareHealthcare SystemsHomeHumanImpairmentIndividualInformaticsInfrastructureInterventionLettersMammographyMeasuresMedicalMethodsModalityModelingNatural Language ProcessingOperative Surgical ProceduresOutcomeOutcome MeasurePatient Care PlanningPatientsPersonsPhasePhysiciansPopulationPreparationRandomizedRandomized, Controlled TrialsReportingResearchResourcesSan FranciscoSocietiesSurgeonSurveysSystemTechnologyTelephoneTestingTextTimeTrainingUnited States Centers for Medicare and Medicaid ServicesUnited States National Institutes of HealthWorkagedarmcare episodedata miningdesigndigital interventiondigital tooleffectiveness evaluationempowermentend of lifeevidence baseexperiencefunctional disabilityhandheld mobile deviceimplementation scienceimprovedinnovationmedical schoolsnovelpatient engagementpatient orientedpatient portalpilot testpreferenceprimary outcomeprogramsremote health caresurrogate decision makertheoriestoolvirtual healthcareweb site
项目摘要
Project Summary
Nearly 20 million older adults undergo major elective surgical procedures, yet very few receive advance care
planning (ACP). This is a critical missed opportunity to ensure optimal and patient-aligned medical decisions and
communications. Despite ACP being incorporated into national quality metrics and society guidelines for surgical
care for older adults, there are few examples of effective integration into the pre-surgical phase. Efforts to date
have mostly focused on improving surgeons’ use of ACP but barriers remain significant, including varying levels
of familiarity and comfort to conduct ACP conversations, lack of dedicated time during the pre-surgical care
episode for these often-delicate conversations, and lack of appropriate patient-facing ACP tools to help patients
and caregivers make complex decisions about their surgical treatment. Our team has designed and tested a
theory-based, interactive ACP patient-facing technology solution (PREPARE) based on the new ACP paradigm
of preparing people for communication and medical decision-making. Despite consistent evidence that
PREPARE increases ACP engagement and patient and clinician empowerment to discuss ACP, a gap remains
in extending PREPARE’s use to pre-surgical populations. We hypothesize that by including PREPARE into the
electronic health record (HER)-centric pre-surgery workflow for older adults and including automated reminders,
we can empower patients and surgical teams to engage in ACP discussions. Given the limited time and
resources in the surgical setting to conduct ACP, we will be testing 3 delivery strategies in increasing resource
intensity (PREPARE alone, PREPARE with text/phone reminders, or the additional of a healthcare navigator).
To ensure generalizability, we will conduct our work in 3 healthcare systems (HCS): Univ. of CA, San Francisco
(UCSF), Univ. of CA, Irvine (UCI) and M Health Fairview (UMN, a collaboration among the Univ. of MN Medical
School, Univ of MN Physicians, and Fairview Health Services). We will first establish trial infrastructure (UG3) to
conduct (UH3) an NIH Stage Model III (efficacy-effectiveness) three arm RCT in 3 HCS. Patients aged 65 or
older, or with serious illness, who are referred for major elective surgery will be randomized to Arms: (1) Letter
about ACP, PREPARE advanced directive (AD), PREPARE website; (2) Letter, AD, PREPARE plus reminder
text/phone messages; (3) Letter, AD, PREPARE plus reminders plus a healthcare navigator on ACP
documentation (discussions and care plans, primary outcome) and patient-reported ACP engagement. Using
mixed methods, we will assess patients’ and surgical care teams' experience with surgery ACP. ACP note
content will be evaluated using natural language processing (NLP) and data mining to begin to identify assess
thematic completeness of ACP notes. This work is innovative because we are coalescing existing collaborations
between HCS into a transdisciplinary group of surgeons, geriatricians, and informaticians across three health
systems that will develop infrastructure and rigorously test a novel patient-centered system-level approach to
integrating ACP into the surgical care episode, the first step towards goal-concordant surgical care.
项目概要
近 2000 万老年人接受重大选择性外科手术,但很少有人接受预先护理
规划(ACP)。这是一个重要的错失机会,无法确保最佳且符合患者的医疗决策和
通讯。尽管 ACP 已纳入国家质量指标和社会外科手术指南
在老年人护理方面,有效融入术前阶段的例子很少。迄今为止的努力
主要关注于改善外科医生对 ACP 的使用,但障碍仍然很大,包括不同程度的障碍
进行 ACP 对话的熟悉度和舒适度,在术前护理期间缺乏专门时间
这些通常是微妙的对话的插曲,并且缺乏适当的面向患者的 ACP 工具来帮助患者
护理人员对其手术治疗做出复杂的决定。我们的团队设计并测试了
基于理论的交互式 ACP 面向患者的技术解决方案 (PREPARE) 基于新的 ACP 范式
帮助人们做好沟通和医疗决策的准备。尽管一致的证据表明
PREPARE 增加了 ACP 参与度以及患者和临床医生讨论 ACP 的权力,但仍存在差距
将 PREPARE 的使用范围扩大到手术前人群。我们假设通过将 PREPARE 纳入
针对老年人的以电子健康记录 (HER) 为中心的术前工作流程,包括自动提醒,
我们可以让患者和手术团队参与 ACP 讨论。鉴于时间有限且
为了进行 ACP,我们将测试 3 种实施策略以增加资源
强度(单独准备、通过短信/电话提醒或附加医疗导航器进行准备)。
为了确保普遍性,我们将在 3 个医疗保健系统 (HCS) 中开展工作:Univ。加利福尼亚州旧金山
(加州大学旧金山分校),大学。加州大学尔湾分校 (UCI) 和 M Health Fairview (UMN,明尼苏达大学医学院之间的合作项目
学校、明尼苏达医师大学和 Fairview 健康服务中心)。我们将首先建立试验基础设施(UG3)
在 3 个 HCS 中进行 (UH3) NIH 阶段模型 III(功效-效果)三组 RCT。 65 岁或
年龄较大或患有严重疾病,被转诊进行重大择期手术的人将被随机分配到组:(1) 字母
关于 ACP、PREPARE 高级指令 (AD)、PREPARE 网站; (2) Letter、AD、PREPARE 加提醒
短信/电话消息; (3) 信函、AD、PREPARE 以及提醒以及 ACP 上的医疗保健导航器
记录(讨论和护理计划、主要结果)和患者报告的 ACP 参与情况。使用
混合方法,我们将评估患者和手术护理团队的 ACP 手术经验。 ACP注释
将使用自然语言处理 (NLP) 和数据挖掘来评估内容,以开始识别评估
ACP 注释的主题完整性。这项工作具有创新性,因为我们正在整合现有的合作
将 HCS 纳入一个由外科医生、老年病学家和信息学家组成的跨学科小组,涵盖三个健康领域
系统将开发基础设施并严格测试以患者为中心的新型系统级方法
将 ACP 纳入手术护理过程中,这是实现目标一致的手术护理的第一步。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Genevieve B Melton-Meaux其他文献
Genevieve B Melton-Meaux的其他文献
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{{ truncateString('Genevieve B Melton-Meaux', 18)}}的其他基金
Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention
对实施可互操作 CDS 预防静脉血栓栓塞的 SCALED(Scaling Acceptable CDS)方法进行评估
- 批准号:
10675563 - 财政年份:2022
- 资助金额:
$ 69.88万 - 项目类别:
Evaluation of the SCALED (SCaling AcceptabLE cDs) Approach for the Implementation of Interoperable CDS for Venous Thromboembolism Prevention
对实施可互操作 CDS 预防静脉血栓栓塞的 SCALED(Scaling Acceptable CDS)方法进行评估
- 批准号:
10494692 - 财政年份:2022
- 资助金额:
$ 69.88万 - 项目类别:
Discovery and Visualization of New Information from Clinical Reports in the EHR
EHR 中临床报告的新信息的发现和可视化
- 批准号:
8476978 - 财政年份:2013
- 资助金额:
$ 69.88万 - 项目类别:
Discovery and Visualization of New Information from Clinical Reports in the EHR
EHR 中临床报告的新信息的发现和可视化
- 批准号:
8739634 - 财政年份:2013
- 资助金额:
$ 69.88万 - 项目类别:
Discovery and Visualization of New Information from Clinical Reports in the EHR
EHR 中临床报告的新信息的发现和可视化
- 批准号:
8930998 - 财政年份:2013
- 资助金额:
$ 69.88万 - 项目类别:
Discovery and Visualization of New Information from Clinical Reports in the EHR
EHR 中临床报告的新信息的发现和可视化
- 批准号:
9145182 - 财政年份:2013
- 资助金额:
$ 69.88万 - 项目类别:
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