Nurse Led Telephonic Care
护士主导的电话护理
基本信息
- 批准号:10709339
- 负责人:
- 金额:$ 247.91万
- 依托单位:
- 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:
- 关键词:AcademyAccident and Emergency departmentAcuteAddressAdvance Care PlanningAlzheimer&aposs DiseaseAlzheimer&aposs disease related dementiaAmbulatory CareAreaBehavioral SymptomsCaringCase ManagementCessation of lifeCharacteristicsChronicCluster randomized trialCommunitiesDataDeliriumDementiaDrug PrescriptionsEffectivenessEmergency CareEmergency department visitEnsureEthnic OriginExclusionHealthHealth systemHealthcare SystemsHomeHospitalizationIatrogenesisIndividualInequityInstitutionalizationInterventionIntervention TrialLeadMedicare claimMedicineModalityNursesOutcomeOutpatientsPainPalliative CareParamedical PersonnelPatientsPersonsPopulationPopulation HeterogeneityPragmatic clinical trialProceduresProcessProviderQuality of CareQuality of lifeRaceRandomizedReach, Effectiveness, Adoption, Implementation, and MaintenanceReportingSiteSurrogate EndpointTelephoneTestingTimeUnited States Agency for Healthcare Research and QualityVariantVisitWorkaccess disparitiesarmcare coordinationcare fragmentationcare systemscomorbiditycost effectivedementia caredeprivationdesigneffectiveness studyeffectiveness trialevidence basehealth care service utilizationhealth equityhealth inequalitieshealth planimplementation fidelityimprovedindexingnovelpain symptompalliativepatient orientedpragmatic trialprimary outcomeprogramspsychological symptomsocialsocial health determinantssuccesssymptom managementuser centered design
项目摘要
PROJECT SUMMARY
The emergency department (ED) is often the care setting of last resort, and is ill suited to provide care for
people living with dementia (PLWD) and their care partners. Many ED visits, which are for ambulatory-care-
sensitive or acute exacerbations of chronic conditions, pain, behavioral and psychological symptoms of
dementia (BPSD), and care partner strain are addressable if intervened upon in the community. Significant
inequity in access to effective outpatient or home-based care further exacerbates who unnecessarily ends up
in the ED. ED visits are also a significant indicator for serious illness in PLWD; 43.1% will have subsequent ED
visits and 31.9% will die within one year. Telephonic nurse-led, interdisciplinary transitional and palliative care
is a cost-effective, patient centered modality shown to both reduce inequities and ED visits. Studies in both
palliative care populations and earlier stages of AD/ADRD without serious illness showed efficacy. However,
this work has not focused on those living with Alzheimer’s Disease and Alzheimer’s Disease-Related
Dementias (AD/ADRD) who are also seriously ill, on large scale “real-world” embedded pragmatic clinical trials,
or with a focus on the ED as site of triggering telephonic care. This project will implement Aliviado Dementia
Care-Telephonic Edition, an evidence-based nurse-led telephonic transition and palliative care intervention
tested end-to-end and widely disseminated in other modalities. The intervention will follow PLWD for 6-months,
and focus on care transitions, assessing and managing BPSD, care partner strain, social determinants of
health and social needs, and conversations about serious illness. In this study, the nurse-led telephonic
intervention will first be optimized for use in conjunction with the two other interventions used in this proposal
(ED Care Redesign and Community Paramedic-led Transitions) in two EDs to ensure effective coordination
when multiple interventions are used. This optimization will follow a user-centered design process and engage
a wide spectrum of stakeholders in coordination with administrative and implementation cores (Aim 1). We will
then conduct a 3-arm embedded pragmatic multifactorial cluster randomized trial that uses Medicare claims
data to test whether nurse-led telephonic care for PLWD alone and in concert with the other interventions
reduces ED visits and hospitalizations, and increases the number of healthy days at home (Aim 2). We will
implement the intervention in 40 EDs in the larger pragmatic trial, tested alone and in conjunction with the other
interventions in a randomized fashion. We will also examine patient- and organization-level factors, including
health inequities that influence implementation and PLWD- and care partner-reported outcomes as part of a
separate implementation analysis (Aim 3). Upon successful completion, this study will provide stakeholders
with the effectiveness data, as well as the implementation and PLWD-Care Partner dyad factors needed to
provide this highly disseminable and implementable form of dyad-centered care with the potential to improve
quality of care and quality of life, and reduce avoidable healthcare utilization in seriously ill PLWD.
项目摘要
急诊科(艾德)通常是最后的护理机构,不适合为患者提供护理。
老年痴呆症患者(PLWD)及其护理伙伴。许多艾德门诊,
敏感或急性加重的慢性疾病,疼痛,行为和心理症状,
痴呆症(BPSD)和护理伙伴应变是可解决的,如果在社区进行干预。显著
在获得有效的门诊或家庭护理方面的不平等进一步加剧了那些不必要地最终
艾德访视也是PLWD严重疾病的重要指标; 43.1%的患者将随后发生艾德
31.9%的人会在一年内死亡。电话护士主导的跨学科过渡和姑息治疗
是一种具有成本效益的、以患者为中心的模式,可减少不公平和艾德就诊。两方面的研究
姑息治疗人群和无严重疾病的AD/ADRD的早期阶段显示出疗效。然而,在这方面,
这项工作并没有集中在那些患有阿尔茨海默病和阿尔茨海默病相关疾病的人身上。
痴呆症(AD/ADRD)谁也是重病,在大规模的“现实世界”嵌入式务实的临床试验,
或者集中在艾德作为触发电话护理的场所。该项目将实施Aliviado痴呆症
护理电话版,一个基于证据的护士主导的电话过渡和姑息治疗干预
经过端到端的测试,并以其他方式广泛传播。干预将在PLWD后进行6个月,
并专注于护理过渡,评估和管理BPSD,护理伙伴压力,
健康和社会需求,以及关于严重疾病的对话。在这项研究中,护士主导的电话
首先,将对干预措施进行优化,以便与本提案中使用的其他两项干预措施结合使用
(ED护理重新设计和社区护理人员领导的过渡),以确保有效协调
当使用多种干预措施时。这种优化将遵循以用户为中心的设计流程,
广泛的利益攸关方与行政和执行核心协调(目标1)。我们将
然后进行一项3臂嵌入式实用多因素群集随机试验,
数据,以测试是否护士为主导的电话护理PLWD单独和与其他干预措施
减少艾德就诊和住院,并增加在家的健康天数(目标2)。我们将
在更大的务实试验中,在40个ED中实施干预,单独测试并与其他
以随机方式进行干预。我们还将研究患者和组织层面的因素,包括
影响实施和PLWD-和护理伙伴报告的结果的健康不公平现象,
单独的实施分析(目标3)。在成功完成后,这项研究将为利益攸关方提供
有效性数据,以及实施和PLWD护理合作伙伴二元因素,
提供这种高度可传播和可实施的以二元为中心的护理形式,
护理质量和生活质量,并减少重病PLWD中可避免的医疗保健利用。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Abraham Aizer Brody其他文献
Abraham Aizer Brody的其他文献
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{{ truncateString('Abraham Aizer Brody', 18)}}的其他基金
ED-LEAD: Emergency Departments LEading the transformation of Alzheimer's and Dementia care
ED-LEAD:急诊科引领阿尔茨海默病和痴呆症护理的变革
- 批准号:
10709334 - 财政年份:2023
- 资助金额:
$ 247.91万 - 项目类别:
Leveraging Electronic Health Records for Reducing Dementia Screening Disparities in Diverse Communities
利用电子健康记录减少不同社区的痴呆症筛查差异
- 批准号:
10525774 - 财政年份:2023
- 资助金额:
$ 247.91万 - 项目类别:
The Hospice Advanced dementia Symptom Management and Quality of Life Trial (HAS-QOL)
临终关怀晚期痴呆症症状管理和生活质量试验 (HAS-QOL)
- 批准号:
10018613 - 财政年份:2019
- 资助金额:
$ 247.91万 - 项目类别:
The Hospice Advanced dementia Symptom Management and Quality of Life Trial (HAS-QOL)
临终关怀晚期痴呆症症状管理和生活质量试验 (HAS-QOL)
- 批准号:
10474598 - 财政年份:2019
- 资助金额:
$ 247.91万 - 项目类别:
The Hospice Advanced dementia Symptom Management and Quality of Life Trial (HAS-QOL)
临终关怀晚期痴呆症症状管理和生活质量试验 (HAS-QOL)
- 批准号:
10007090 - 财政年份:2019
- 资助金额:
$ 247.91万 - 项目类别:
The Hospice Advanced dementia Symptom Management and Quality of Life Trial (HAS-QOL)
临终关怀晚期痴呆症症状管理和生活质量试验 (HAS-QOL)
- 批准号:
10248435 - 财政年份:2019
- 资助金额:
$ 247.91万 - 项目类别:
P20 Exploratory Center for Precision Health in Diverse Populations
P20多元化人群精准健康探索中心
- 批准号:
10175058 - 财政年份:2018
- 资助金额:
$ 247.91万 - 项目类别: