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.
项目总结
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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