Emergency Care Redesign (ECR)

紧急护理重新设计 (ECR)

• 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
• 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' s Disease; Alzheimer' s disease related dementia; Alzheimer' 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

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.

项目概要 痴呆症患者 (PLWD) 及其护理伙伴前往急诊室 (ED) 更多 比那些不受影响的人更频繁，并且面临与管理相关的独特而复杂的挑战 阿尔茨海默病和阿尔茨海默病相关痴呆 (AD/ADRD) 并出现症状。 基于团队的痴呆症护理对 PLWD 效果良好，并且紧急护理重新设计干预措施 (UH3AT009844) 为紧急情况提供者提供的新的、有意的工作流程，通过数字警报得到加强 增加预先护理计划并争取多学科支持。心理社会挑战和 AD/ADRD 护理固有的复杂性需要一种方法来简化可行的评估并确保采用 基于紧急护理团队的策略。简化方法以反映更少的时间密集度和更多的时间 务实的干预，同时关注所需的知识、敏感性和实现最佳护理的结构 对于 PLWD 及其护理伙伴（二人）来说，需要三个核心组成部分：1）识别问题； 2） 优先考虑问题（包括护理目标）； 3) 建立可行的、社会心理敏感的 干预措施。虽然这些组成部分对于减少急诊室复诊和其他关键后果至关重要 对于二人来说很重要，如果没有嵌入式结构和信息支持，这样的结果是不可能的 强调并鼓励与高质量紧急护理相一致的护理流程的工作流程。这 拟议的干预措施“紧急护理重新设计”将提供经过试验测试的痴呆症护理的核心组成部分 管理计划，嵌入紧急护理提供者（护士、 医生、执业护士、医生助理和社会工作者），为 PLWD 提供临床决策支持 通知、提醒和强化教学简短视频，这是一个共享的结构化工作表 用于急需评估和数据采集、审计和反馈支持的电子健康记录 每两周进行一次病例审查咨询，以及一次访问后社会工作电话，以加强社区转介 所有到急诊室就诊的 PLWD。我们将在一个急诊室内优化这一针对痴呆症的重新设计的急性护理 （紧急护理重新设计），然后在 14 个卫生系统内 80 个急诊室中的 40 个实施该计划 遍布美国。我们将测试紧急护理重新设计知情程序的有效性 用于护理 PLWD 和护理伙伴，无论是作为单一干预措施还是与护士主导的相结合 电话护理和/或社区护理人员主导的群体随机过渡干预， 多因素试验（在这 40 家机构中），结果如下： 急诊科在治疗后 30 天内进行重访 急诊室出院后 6 个月内的索引访视、住院治疗和在家健康天数。我们将确定地点， 与实施和变化的保真度相关的提供者、患者和护理合作伙伴级别的特征 ED 痴呆症知情护理的影响。这种干预措施有望减少急诊室复诊，同时提供 基于证据的现实世界护理，以改善患有严重疾病的 PLWD 及其护理伙伴的生活。