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Community Paramedicine

社区辅助医疗

基本信息

批准号：
10709340
负责人：
MANISH N SHAH
金额：
$ 232.82万
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/10709340
关键词：
Accident and Emergency department Address Adverse event Alzheimer&apos s Disease Applied Research Area Caring Characteristics Communication Communities Community Health Community Trial Dementia Education Effectiveness Effectiveness of Interventions Elderly Emergency Care Emergency Department patient Emergency department visit Emergency response Foundations Funding Health Health Planning Organizations Health Services Health system Healthcare Home Home visitation Hospitalization Hospitals Impaired cognition Intervention Intervention Studies Lead Managed Care Programs Measures Medical Mental Depression Nurses Outcome Paramedical Personnel Patient Discharge Patients Persons Population Positioning Attribute Pragmatic clinical trial Provider Publishing Randomized Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Recovery Resources Risk Role Site Structure Symptoms Telephone Testing United States United States Centers for Medicare and Medicaid Services Vaccination Variant Visit Vulnerable Populations Work advanced dementia community intervention community setting cost dementia care deprivation design effectiveness testing experience future implementation health care model hospice environment implementation fidelity implementation intervention improved indexing innovation member mortality primary outcome provider adoption screening secondary outcome skills social disparities

项目摘要

PROJECT SUMMARY Approximately 3 million known persons living with dementia (PLWD) visit the emergency department (ED) annually. This is likely an underestimated value as most cases of dementia go unrecognized in the ED. Most PLWD are treated and released, implying that they do not need medical oversight and are on the road to recovery. Yet, for PLWD, the ED-to-home transition is associated with increased risk of ED revisits, adverse events, and mortality. The critical need for effective care transition interventions for PLWD has been identified by the NIA-funded Geriatric Emergency Care Applied Research 2.0 Network – Advancing Dementia Care. Our adaptation of the Coleman’s Care Transitions Intervention, delivered by community paramedics for community- dwelling older adults transitioning from ED-to-home, reduced the odds of ED revisits within 30 days by 75% among patients with cognitive impairment. These results lay the foundation for testing the Community Paramedic-Led Transitions Intervention (CPTI) in a large-scale embedded pragmatic clinical trial to rigorously evaluate its effectiveness in improving the ED-to-home transitions for PLWD. In this study, we will test our hypothesis that the CPTI will improve the ED-to-home transition and utilization outcomes for PLWD, both alone and when combined with other interventions. We will leverage community paramedicine, an innovative and new health care model where paramedics function outside their traditional roles to deliver community health interventions. We will optimize the CPTI across two sites in coordination with the Nurse-led Telephonic Care and ED Care Redesign for PLWD, assessing intervention acceptability and engagement. We will test the CPTI’s effectiveness alone and in combination with the other interventions in an 80-center, cluster- randomized, multifactorial embedded pragmatic clinical trial for community-dwelling PLWD and their care partners experiencing an ED visit by analyzing ED revisit rates, hospitalizations, and total days at home following an index ED visit. We will also determine site, provider, and patient-level characteristics that are associated with CPTI outcome variations using the RE-AIM framework, such that future implementation can adequately address these care gaps. Upon its completion, this study will address the important gap of overlooked ED-to-home transitions for PLWD receiving ED care. By rigorously investigating the CPTI, we will provide critical evidence on ways to improve PLWD health outcomes and enable underutilized healthcare resources for this vulnerable population.

项目概要大约 300 万已知痴呆症患者 (PLWD) 到急诊室 (ED) 就诊每年。这可能是一个被低估的值，因为大多数痴呆症病例在急诊室都未被识别出来。最多残疾人得到治疗并出院，这意味着他们不需要医疗监督，正在走向康复之路恢复。然而，对于 PLWD 来说，从急诊室到家庭的过渡与急诊室再次就诊的风险增加相关，不利事件和死亡率。已确定 PLWD 迫切需要有效的护理过渡干预措施由 NIA 资助的老年紧急护理应用研究 2.0 网络 – 推进痴呆症护理。我们的由社区护理人员为社区提供的科尔曼护理过渡干预的改编居住老年人从急诊室过渡到家庭，30 天内再次就诊急诊室的几率降低了 75% 在患有认知障碍的患者中。这些结果为测试社区奠定了基础护理人员主导的过渡干预（CPTI）在大规模嵌入式实用临床试验中严格评估其在改善 PLWD 急诊室到家庭过渡方面的有效性。在这项研究中，我们将测试我们的假设 CPTI 将改善 PLWD 的 ED 到家庭的过渡和利用结果，无论是单独使用还是与其他干预措施结合使用。我们将利用社区辅助医疗，创新和新的医疗保健模式，护理人员在其传统角色之外发挥作用，提供服务社区健康干预措施。我们将与护士主导的协调，优化两个站点的 CPTI 针对 PLWD 的电话护理和急诊护理重新设计，评估干预的可接受性和参与度。我们将在 80 个中心的集群中单独测试 CPTI 的有效性以及与其他干预措施相结合的有效性针对社区居住的 PLWD 及其护理的随机、多因素嵌入式实用临床试验通过分析急诊室复诊率、住院情况和在家总天数来了解急诊室就诊的合作伙伴进行索引急诊就诊后。我们还将确定站点、提供者和患者级别的特征使用 RE-AIM 框架与 CPTI 结果变化相关联，以便未来的实施可以充分解决这些护理差距。完成后，这项研究将解决以下重要空白：接受急诊室护理的 PLWD 被忽视了从急诊室到家庭的过渡。通过严格调查 CPTI，我们将提供关于改善 PLWD 健康结果和实现未充分利用的医疗保健的方法的关键证据为这一弱势群体提供资源。