权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Emergency Care Redesign (ECR)

紧急护理重新设计 (ECR)

基本信息

批准号：
10709338
负责人：
JOSHUA CHODOSH
金额：
$ 207.58万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
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：
2023-09-15 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10709338
关键词：
Accident and Emergency department Address Adoption Advance Care Planning Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Alzheimer&apos s disease test Area Caring Characteristics Collaborations Communication Communities Complex Consultations Delirium Dementia Drug Prescriptions Education Electronic Health Record Emergency Care Emergency Nursing Emergency Situation Emergency department visit Engineering Ensure Environment Ethnic Origin Face Feedback Goals Health Health Care Sector Health system Healthcare Systems Home Hospitalization Iatrogenesis Informatics Institutionalization Instruction Intervention Knowledge Lead Managed Care Programs Medicine Mental Depression Modeling Needs Assessment Notification Nurse Practitioners Nurses Outcome Paramedical Personnel Pathway interactions Patients Persons Physician Assistants Physicians Population Procedures Process Provider Psychological reinforcement Quality of life Race Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reporting Resources Schedule Site Social Work Social Workers Specific qualifier value Structure Symptoms Telephone Testing Time Training United States United States National Academy of Sciences Variant Visit Work acute care care fragmentation care providers clinical decision support data acquisition dementia care deprivation design digital effective intervention effectiveness study effectiveness testing evidence base health inequalities implementation fidelity improved indexing multidisciplinary pragmatic intervention pressure primary outcome programs psychosocial response skills team-based care therapy design

项目摘要

PROJECT SUMMARY Persons living with dementia (PLWD) and their care partners visit the emergency department (ED) more frequently than those who are unaffected, and face unique and complex challenges associated with managing Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) and presenting symptoms. Team-based dementia care has worked well for PLWD, and an emergency care redesign intervention (UH3AT009844) of new and intentional workflows for emergency providers reinforced by digital alerts has increased advance care plans and enlisted multidisciplinary support. The psychosocial challenges and the inherent complexity of AD/ADRD care beg for a way to simplify a feasible assessment and ensure adoption of an emergency care team-based strategy. Simplifying an approach to reflect a less time-intensive and more pragmatic intervention while attending to needed knowledge, sensitivities, and a structure to achieve best care for PLWD and their care partners (dyads) requires three core components: 1) identifying problems; 2) prioritizing problems (inclusive of goals of care); and 3) establishing feasible, psychosocially sensitive interventions. While these components are essential to reduce ED revisits and other outcomes of critical importance to dyads, such results are unlikely without an embedded structure and an informatic-supported workflow that emphasizes and encourages care processes congruent with high-quality emergency care. The proposed intervention, Emergency Care Redesign, will provide core components of trial-tested dementia care management programs, embedded within an educational structure for emergency care providers (nurses, physicians, nurse practitioners, physician assistants, and social workers), clinical decision supports for PLWD notification, reminders and instructional brief videos for reinforcement, a shared structured worksheet in the electronic health record for critically needed assessments and data acquisition, audit and feedback supporting a biweekly case-review consultation, and a post visit social work phone call to reinforce community referrals for all PLWD who visit the ED. We will optimize, within one ED, this dementia-informed redesigned acute care (Emergency Care Redesign) and then implement this program in 40 out of 80 EDs within 14 health systems throughout the United States. We will test the effectiveness of emergency care redesign-informed procedures for the care of PLWD and care partners either as a single intervention or in combination with nurse-led telephonic care and/or a community paramedic-led transitions intervention in a cluster-randomized, multifactorial trial (in these 40 facilities) on the following outcomes: ED revisits within 30 days following the index visit, hospitalizations, and healthy days at home within 6 months of ED discharge. We will determine site, provider, patient, and care partner-level characteristics associated with fidelity of implementation and variation in impact of ED dementia-informed care. This intervention promises to reduce ED revisits while providing evidence-based, real-world care to improve the lives of PLWD with serious illness and their care partners.

项目总结