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Emergency General Surgery Delirium Recovery Model: A Collaborative Care Intervention

急诊普通外科谵妄恢复模型：协作护理干预

基本信息

批准号：
10649684
负责人：
MALAZ BOUSTANI
金额：
$ 204.11万
依托单位：
UNIVERSITY OF WISCONSIN-MADISON
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10649684
关键词：
Activities of Daily Living Acute Address Adhesions Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American Caring Chronic Chronic Care Chronic Disease Cognition Cognitive Colectomy Complex Conscious Country Cytolysis Delirium Dementia Dependence Elderly Emergency Situation Excision Generalized Anxiety Disorder Goals Health Health Services Hospitalization Hospitals Human Impaired cognition Indiana Intervention Intra-abdominal Knowledge Laparotomy Lead Life Expectancy Managed Care Measures Medical Mental Depression Mission Modeling Morbidity - disease rate Neuropsychology Operative Surgical Procedures Outcome Study Patients Peptic Ulcer Physical Performance Physicians Positioning Attribute Postoperative Period Primary Care Psyche structure Public Health Quality of Care Quality of life Questionnaires Randomized Randomized Controlled Clinical Trials Randomized, Controlled Trials Recovery Recovery of Function Research Research Personnel Risk Small Intestines Survivors Syndrome Time United States National Institutes of Health Universities Wisconsin Work anxiety symptoms biopsychosocial cognitive recovery collaborative care disability efficacy evaluation emergency settings evidence base experience feasibility testing frailty functional decline functional independence functional loss health care service utilization high risk human old age (65+)improved indexing innovation medical schools medical specialties meetings mood symptom neuropsychiatry operation patient population personalized care postoperative delirium prevent programs psychologic recruit repaired telehealth treatment as usual

项目摘要

Project Summary Delirium is a complex neuropsychiatric syndrome characterized by acute and fluctuating changes in cognition and consciousness. Delirium survivors suffer from a cluster of cognitive, physical, and psychological disabilities. These disabilities lead to high healthcare utilization, lower quality of life, and loss of functional independence. Worse, a single episode of delirium increases the risk of Alzheimer disease and related dementias. Based on work from our group and the work of others, over 25% of patients who undergo emergency intra-abdominal surgery suffer from at least one episode of delirium during the index hospitalization, putting them at high risk for cognitive decline. There is a fundamental gap in knowledge regarding the best way to prevent cognitive, psychological and functional decline in patients who undergo emergency general surgery and subsequently develop delirium. The long-term goal of this line of research is to improve the health and quality of care for older emergency general surgery survivors. The objective of this application is to apply the concepts of collaborative care to a high-risk patient population. Indiana University School of Medicine and University of Wisconsin School of Medicine and Public Health researchers have over 20 years of experience developing innovative and effective collaborative care models that integrate with primary care and specialty physicians to address the complex biopsychosocial needs of patients with chronic disease states, such as dementia and depression. Our team has developed a specific collaborative care model called the Emergency General Surgery Delirium Recovery Program. This proposal aims to conduct a randomized controlled trial to evaluate the efficacy of 12-months of collaborative care in improving the cognitive, functional and psychological recovery of emergency intra-abdominal surgery patients who suffer at least one episode of delirium in the post-operative period and are at least 65 years old. The trial has the following specific aims: 1) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the cognitive recovery of older Emergency General Surgery delirium survivors; and 2) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the physical recovery of older Emergency General Surgery delirium survivors; and 3) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the psychological recovery of older Emergency General Surgery delirium survivors. The research proposed in this application is innovative because it represents a new and substantive departure from the status quo. Previous collaborative care models focused on chronic care management and they lack rapid adaptability. We have also adapted the intervention to be completed solely via telehealth. This contribution will be significant as broad application of the Emergency General Surgery Delirium Recovery Program at hospitals across the country could result in better health and improved quality of care for a particularly vulnerable patient population.

项目摘要谵妄是一种复杂的神经精神综合征，以认知功能的急性波动性改变为特征和意识。谵妄幸存者遭受一组认知，身体和心理残疾。这些残疾导致高医疗保健利用率，生活质量下降，功能丧失，独立更糟糕的是，一次谵妄发作会增加患阿尔茨海默病和相关疾病的风险。痴呆症根据我们小组的工作和其他人的工作，超过25%的患者接受急诊腹腔内手术期间至少有一次谵妄发作住院治疗，使他们面临认知能力下降的高风险。在知识上存在着根本性的差距关于预防认知、心理和功能下降的最佳方法，急诊普通外科手术，随后出现谵妄。这项研究的长期目标是改善老年急诊普外科幸存者的健康和护理质量。的目的应用是将协作护理的概念应用于高风险患者群体。印第安纳州大学医学院和威斯康星州大学医学与公共卫生学院的研究人员已经超过 20年的经验，开发创新和有效的协作护理模式，初级保健和专科医生，以解决慢性病患者复杂的生物心理社会需求疾病状态，如痴呆症和抑郁症。我们的团队开发了一种特定的协作护理模式叫做紧急普通外科谵妄恢复计划这项建议旨在进行一项随机对照试验，以评估12个月的协作护理在改善急诊腹腔手术患者的认知、功能和心理恢复在术后至少有一次谵妄发作，年龄至少为65岁。审判有以下具体目标：1）评价急诊普通外科谵妄恢复模型的能力，改善老年急诊普外科谵妄幸存者的认知恢复; 2）评估急诊普通外科谵妄恢复模型改善老年人身体恢复的能力急诊普外科谵妄幸存者; 3）评估急诊普外科的能力谵妄康复模式对提高老年急诊普外科谵妄患者心理康复的作用幸存者本申请中提出的研究是创新的，因为它代表了一种新的实质性的脱离现状。以前的合作护理模式侧重于慢性病护理管理，缺乏快速的适应能力。我们还调整了干预措施，仅通过远程保健完成。这贡献将是显着的广泛应用的紧急普通外科谵妄恢复全国各地医院的计划可以改善健康状况，提高护理质量，尤其是弱势患者群体。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Delirium and neuropsychological recovery among emergency general surgery survivors (DANE): study protocol for a randomized controlled trial and collaborative care intervention.

DOI：
10.1186/s13063-023-07670-w
发表时间：
2023-10-03
期刊：
Trials
影响因子：
2.5
作者：
通讯作者：

Delirium and Neuropsychological Recovery among Emergency General Surgery Survivors (DANE): study protocol for a randomized controlled trial and collaborative care intervention.

紧急普通手术幸存者 (DANE) 中的谵妄和神经心理恢复：随机对照试验和协作护理干预的研究方案。

DOI：
10.21203/rs.3.rs-3185716/v1
发表时间：
2023
期刊：
Research square
影响因子：
0
作者：
Mohanty,Sanjay;Holler,Emma;Ortiz,Damaris;Meagher,Ashley;Perkins,Anthony;Bylund,Peggy;Khan,Babar;Unverzagt,Frederick;Xu,Hupuing;Ingraham,Angela;Boustani,Malaz;Zarzaur,Ben
通讯作者：
Zarzaur,Ben