Discharge care transitions for patients with dementia: a qualitative study of Hispanic patients' and families' experiences in the ED.

痴呆症患者的出院护理转变：对西班牙裔患者和家属在急诊室经历的定性研究。

• 批准号: 10832878
• 负责人: Ula Y Hwang
• 金额: $ 5.19万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2023-09-22
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10832878
• 关键词: Accident and Emergency department; Address; Admission activity; Advocate; Age; Black race; Caregivers; Caring; Communication; Community Services; Consent; Dementia; Dementia caregivers; Detection; Diagnosis; Discrimination; Documentation; Elderly; Eligibility Determination; Emergency Care; Enrollment; Environment; Ethnic Origin; Ethnic Population; Family; Family Caregiver; Family member; Future; Goals; Health; Health Personnel; Health Services; Healthcare; Healthcare Systems; Hispanic; Hospitalization; Hospitals; Impaired cognition; Intervention; Interview; Language; Latino; Latinx population; Literature; Minority; Minority Groups; Outcome; Parents; Participant; Pathway interactions; Patients; Perception; Persons; Physicians; Play; Policies; Population; Positioning Attribute; Prevalence; Process; Protocols documentation; Quality of Care; Questionnaires; Race; Reporting; Research; Research Design; Research Personnel; Role; Socioeconomic Status; Structure; Surveys; United States; care fragmentation; comorbidity; dementia care; dementia risk; emotional distress; experience; health literacy; high risk; improved; minority patient; prevent; programs; racial bias; racial population; racism; recruit; shared decision making; social health determinants; social stigma; training opportunity

Project Abstract: The older adult population in the United States is becoming increasingly diverse, more are seeking ED- based care, detection and documentation of dementia is improving, and informal family caregivers are playing a greater role in navigating the healthcare system, particularly within minoritized populations. Due to these changes, it is therefore critical to identify the unique challenges minoritized patients with dementia and their families experience during ED care transitions. Numerous studies have documented differences in dementia prevalence among racial and ethnic groups in the US and have found that Black and Hispanic/Latinx populations have a higher risk of dementia compared to White populations. Thus, it is critical to understand the perspectives of patients and their family members to gain a better understanding of the factors and relationships influencing ED discharge care transition experiences for underrepresented patients with dementia. This supplement seeks to fill a significant gap in the literature by exploring approaches to ED discharge care transition experiences for Hispanic patients with dementia. Using participant surveys and qualitative interviews, the supplement will be guided by the following aims: Research Aim 1: We will explore how Hispanic patients with dementia, and patient family members approach the ED discharge care decision process. Specifically, we seek to understand the facilitators and barriers for making patient goal-concordant care decisions. Research Aim 2: We will explore the perceived ED experiences of persons living with dementia and their family members after the patients have been discharged. Specifically, we will examine discharge pathways, perceived communication quality, and perceptions of ED environments. The study design will be a qualitative exploratory study. Eligible subjects will be recruited from the ED setting and include patients >65 age, with a documented dementia diagnosis, and discharged from the ED. Patients and dyads (patients and their identified care partner) will be consented and enrolled to complete an in-ED questionnaire and participate in a subsequent qualitative interview. Results will address gaps in understanding about emergency care transitions and communication and shared decision-making barriers for dementia patients seen in the ED that may be underserved and identify as Hispanic/Latino(a). The supplement will provide training opportunities and experiential research for Ms. Sandoval that will equip and position her well as a strong applicant to doctoral programs and future investigator.

项目摘要： 美国的老年人口越来越多样化，越来越多的人寻求艾德- 基础护理，痴呆症的检测和记录正在改善，非正式的家庭护理人员正在发挥作用， 在医疗保健系统中发挥更大的作用，特别是在少数群体中。由于这些 因此，确定少数痴呆症患者及其 家庭在艾德护理过渡期间的经历。许多研究都记录了痴呆症的差异 在美国种族和民族群体中的流行率，并发现黑人和西班牙裔/拉丁裔 与白色人群相比，老年人人群患痴呆症的风险更高。因此，理解 患者及其家属的观点，以更好地了解这些因素， 影响艾德出院护理过渡经验的关系， 痴呆 本补充旨在填补一个显着的差距，在文献中探索的方法，以艾德 西班牙裔痴呆症患者的出院护理过渡经验。使用参与者调查和 定性访谈，补充将遵循以下目标：研究目标1：我们将探索 西班牙裔痴呆患者和患者家属如何处理艾德出院护理决定 过程具体来说，我们试图了解促进者和障碍，使病人的目标一致 护理决策。研究目的二：探讨失智症患者的认知艾德经验 病人出院后，他们的家人。具体来说，我们将检查出院 路径，感知的沟通质量，以及对艾德环境的感知。研究设计将是 定性探索性研究。合格的受试者将从艾德环境中招募，包括>65岁的患者 年龄，有记录的痴呆诊断，并从ED出院。患者和二人组（患者和 他们确定的护理伴侣）将获得同意并入组，以完成ED内问卷并参与 在随后的定性访谈中。结果将解决对紧急护理的理解方面的差距 在艾德中看到的痴呆症患者的过渡、沟通和共同决策障碍， 可能服务不足，并确定为西班牙裔/拉丁美洲人（a）。该补编将提供培训机会， 经验研究女士桑多瓦尔，将装备和定位她以及作为一个强大的申请博士 项目和未来的研究者。