Developing a PREPARE for Your Care delivery system to enhance adoption by healthcare organizations

开发 PREPARE for Your Care 交付系统以提高医疗机构的采用率

• 批准号: 10546110
• 负责人: David Farrell
• 金额: $ 25.8万
• 依托单位: PEOPLE DESIGNS, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10546110
• 关键词: Academic Medical Centers; Address; Adopted; Adoption; Advance Care Planning; Advance Directives; Aging; Agreement; California; Caring; Chronic Disease; Clinical; Communication; Communities; Companions; Complex; Copyright; County; County Hospitals; Data; Decision Making; Documentation; Elderly; Ensure; Event; Face; Feedback; Funding; Future; Geographic state; Goals; Health; Health system; Healthcare; Healthcare Systems; Hospitals; Individual; Interview; Language; Lead; Licensing; Linguistics; Measures; Medical; Medical Records; Methods; Modeling; Outcome; Pamphlets; Patients; Phase; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Preparation; Process; Public Health; Public Hospitals; Reach Effectiveness Adoption Implementation and Maintenance; Reduce health disparities; Reporting; Research; Small Business Innovation Research Grant; Surveys; System; Testing; Time; Translating; United States National Institutes of Health; Universities; advanced disease; base; care delivery; commercialization; community organizations; course development; design; end of life; evidence base; fifth grade; health care service organization; health disparity; health literacy; improved; informant; marginalized community; movie; novel; pilot test; preference; programs; prototype; satisfaction; skills; theories; tool; web site

PROJECT SUMMARY Background: The population is aging, chronic illness is increasing, and millions of older adults lack preparation for complex medical decision making, leading to uninformed decisions and care inconsistent with personal goals. The goal of advance care planning (ACP) is to ensure that patients receive medical care aligned with their goals and preferences. Our team has created the evidenced-based, interactive online PREPAREforYourCare.org (PREPARE) ACP program that helps English and Spanish-speaking individuals develop the skills to clarify their values, communicate their wishes, and make informed medical decisions. In trials, PREPARE helped 98% of English and Spanish-speaking older adults engage in ACP and increased documentation of ACP decisions in the medical record up to 43%. Since 2013, PREPARE has had over 350,000 unique users and the materials have been translated into multiple languages; yet reach and adoption by healthcare systems remains low due to burdensome licensing and purchasing complexity, packaging of PREPARE materials that may not meet organizations’ needs, and lack of guidance for how to integrate the materials into clinical workflows. The objective of this proposal is to develop, refine, and evaluate an adopter-focused PREPARE Delivery System (PDS) to ease the process of selecting, licensing, and implementing PREPARE within healthcare organizations. The goal is to improve adoption and profitability of PREPARE and to position the team to apply for Phase II SBIR funding to test adoption and implementation among varying types of healthcare and related organizations. Aim 1: We will determine what PREPARE assets (i.e., website, advance directives, pamphlets, videos), are wanted by healthcare organizations and how organizations want to access and license the assets. Aim 2: We will build a PDS prototype that includes the desired assets and addresses stakeholder barriers to licensing and implementation. Aim 3: We will determine the feasibility of the PDS by pilot testing among stakeholder potential adopters. Methods: We will conduct in-depth interviews with healthcare stakeholders from a wide range of potential adopting organzations including community-based hospitals, county hospitals, tertiary academic medical centers, and healthcare-based community organizations and analyze the data using qualitative content analysis (Aims 1 and 2). We will also assess feasibility and satisfaction with the PDS using validated surveys and in-depth interviews (Aim 3). We hypothesize that stakeholders will identify preferred PREPARE assets and barriers to adoption, continue to provide feedback on needed refinements of the PDS over the course of development, and report that the PDS is feasible and report high satisfaction with the deliveray system. Relevance to NIH and public health: Widespread adoption and implementation of the evidenced-based PREPARE program may reduce health disparities in ACP among culturally and linguistically diverse older adults. Expected Outcomes include a functional PDS prototype and preliminary data to apply for Phase II funding in which we will further develop and deploy the PDS and measure adoption and dissemination of the PREPARE program within healthcare systems.

项目概要 背景：人口老龄化，慢性疾病增加，数百万老年人缺乏准备 复杂的医疗决策，导致不知情的决定和与个人目标不一致的护理。目标是 预先护理计划 (ACP) 旨在确保患者接受符合其目标和偏好的医疗护理。我们的 团队创建了基于证据的交互式在线 PREPAREforYourCare.org (PREPARE) ACP 计划 帮助英语和西班牙语人士培养阐明价值观、表达愿望和的技能 做出明智的医疗决定。在试验中，PREPARE 帮助 98% 的英语和西班牙语老年人参与 ACP 并将病历中 ACP 决策的记录增加至 43%。自 2013 年以来，PREPARE 已 超过 350,000 个唯一用户，材料已被翻译成多种语言；尚未达到并采用 由于繁重的许可和采购复杂性、PREPARE 的包装，医疗保健系统仍然较低 材料可能无法满足组织的需求，并且缺乏如何将材料整合到临床中的指导 工作流程。该提案的目标是开发、完善和评估以采用者为中心的 PREPARE Delivery 系统 (PDS) 可简化医疗机构内选择、许可和实施 PREPARE 的流程。 目标是提高 PREPARE 的采用率和盈利能力，并使团队能够申请第二阶段 SBIR 提供资金来测试不同类型的医疗保健和相关组织的采用和实施。目标一：我们将 确定医疗保健机构需要哪些 PREPARE 资产（即网站、预先指示、小册子、视频） 组织以及组织希望如何访问和许可资产。目标 2：我们将构建一个 PDS 原型 包括所需的资产并解决利益相关者在许可和实施方面的障碍。目标 3：我们将确定 通过在利益相关者潜在采用者中进行试点测试来确定 PDS 的可行性。方式：我们将深入开展 采访来自各种潜在采用组织（包括基于社区的组织）的医疗保健利益相关者 医院、县医院、三级医疗中心和医疗保健社区组织并进行分析 使用定性内容分析来分析数据（目标 1 和 2）。我们还将评估 PDS 的可行性和满意度 使用经过验证的调查和深入访谈（目标 3）。我们假设利益相关者会确定首选 准备资产和采用障碍，继续提供有关 PDS 所需改进的反馈 开发过程，并报告 PDS 是可行的，并对交付系统表示高度满意。 与 NIH 和公共卫生的相关性：基于证据的 PREPARE 的广泛采用和实施 该计划可以减少文化和语言不同的老年人中 ACP 的健康差异。预期的 结果包括功能性 PDS 原型和申请第二阶段资金的初步数据，我们将进一步 开发和部署 PDS 并衡量 PREPARE 计划在医疗保健领域的采用和传播 系统。