Improving Primary Care Clinicians’ Advance Care Planning for Persons Living with Alzheimer’s Disease and Related Dementias

改善初级保健临床医生对阿尔茨海默病和相关痴呆症患者的预先护理计划

• 批准号: 10670480
• 负责人: Christine E Kistler
• 金额: $ 38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10670480
• 关键词: Address; Administrator; Adoption; Advance Care Planning; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Assisted Living Facilities; Attention; Black Populations; Black race; Cardiology; Caregivers; Caring; Cessation of life; Clinic; Clinical; Clinical Research; Clinical Trials; Communication; Communities; Consolidated Framework for Implementation Research; Dementia; Dementia caregivers; Diagnosis; Documentation; Elderly; Emergency department visit; Ensure; Evaluation; Family; Family member; Feedback; Goals; Healthcare; Healthcare Systems; Hospitalization; Integrated Health Care Systems; Intervention; Interview; Length of Stay; Life; Measures; Medical; Medicare; Mission; Modeling; National Institute on Aging; Nurses; Nursing Homes; Oncology; Online Systems; Outcome; Outcome Measure; Outpatients; Palliative Care; Patient Care Team; Patients; Persons; Physicians; Population; Population Heterogeneity; Positioning Attribute; Primary Health Care; Process; Proctor framework; Progressive Disease; Provider; Public Health; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Research; Research Design; Sampling; Social Workers; Specific qualifier value; Survey Methodology; Surveys; Terminal Disease; Testing; Time; Training and Education; Treatment Efficacy; United States National Institutes of Health; Variant; Work; beneficiary; clinical care; clinical data warehouse; community living; decision-making capacity; dementia care; design; effectiveness trial; efficacy outcomes; evidence base; experience; group intervention; health care service utilization; health disparity; hospice environment; implementation evaluation; implementation outcomes; improved; medical specialties; minority communities; neurodegenerative dementia; operation; portability; post intervention; preference; primary outcome; secondary analysis; secondary outcome; skills; surrogate decision maker; treatment as usual; trial comparing; web site

PROJECT SUMMARY/ABSTRACT Advance care planning (ACP) is difficult for all older adults, but dementia makes ACP even more difficult. Alzheimer's disease and Alzheimer's disease related neurodegenerative dementias (AD/ADRD) are incurable, progressive and terminal diseases with unparalleled impact on the US healthcare system, patients and families. Over 5 million Americans live with AD/ADRD, and people with AD/ADRD lose decision-making capacity years in advance of critical and serious medical illness. Clinicians must discern when and how people with AD/ADRD can express valid treatment preferences at all stages of AD/ADRD. Additionally, significant disparities exist for people with AD/ADRD in minority communities. Most people with AD/ADRD are managed by their primary care clinics whose primary care teams receive little education and training on dementia management, and no attention to dementia-specific ACP communication needs. Primary care teams, including physicians, advance practice providers, nurses and social workers, are well-positioned to empower people living with AD/ADRD (PLwD) and their families in ACP, especially minority communities, yet lack critical dementia-specific communication skills. Evidence-based ACP interventions for PLwD are rare, and no prior clinical trial addresses AD/ADRD ACP in primary care with a focus on health disparities in Black PLwD. Our experienced investigative team has demonstrated feasibility and preliminary efficacy of an AD ACP practice improvement toolkit (AD ACP toolkit) for primary care teams. We will test whether our AD ACP toolkit will enable primary care teams to better conduct GOC discussions more efficiently and thus increase the number of GOC discussions held as compared to controls. We will deliver the AD ACP toolkit to 10 intervention primary care clinics and usual care to 10 control clinics with large Black populations within a large integrated health care system. Our first aim is to conduct a trial comparing the AD ACP Toolkit to usual care on goals of care discussions and other ACP measures (N=600). We will conduct stratified analyses for Black PLwD. The second aim is to examine the 18-month healthcare utilization outcomes for all PLwD served by intervention vs control clinics and conduct secondary analyses for Black PLwD. Lastly, we will assess implementation via surveys in the intervention clinics (N=120) followed by interviews (N=60) to understand any disparities in ACP for Black PLwD. This project addresses National Institute on Aging's mission to improve care for older adults with AD/ADRD in primary care. This work will improve how to incorporate ACP approaches for aging-related conditions by primary care teams and may be adaptable to other outpatient specialties such as oncology or cardiology.

项目总结/文摘