Community Paramedicine

项目总结 约300万已知的痴呆症患者(PLWD)前往急诊科(ED)就诊 每年一次。这可能是一个被低估的价值，因为大多数痴呆症病例在急诊室都没有被识别出来。多数 PLWD得到治疗并出院，这意味着他们不需要医疗监督，正在 恢复。然而，对于PLWD来说，从ED到Home的转变与ED再次就诊的风险增加相关，不利 事件，和死亡。已经确定了对PLWD进行有效的护理过渡干预的迫切需要 由NIA资助的老年急救应用研究2.0网络-推进痴呆症护理。我们的 社区护理人员为社区提供的科尔曼护理过渡干预的改编- 居住的老年人从急诊室过渡到家，将30天内再次就诊的几率降低75% 在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性干预(CPTI)在大规模嵌入式务实临床试验中的严格执行 评估其在改善PLWD从ED到Home过渡方面的有效性。在本研究中，我们将测试我们的 假设CPTI将改善可持续发展教育到家庭的过渡和利用结果， 无论是单独还是与其他干预措施相结合。我们将利用社区辅助医疗，以及 创新和新的医疗保健模式，护理人员的职能超越了他们的传统角色 社区卫生干预。我们将在护士领导的协调下，优化两个地点的CPTI 电话护理和急诊护理为PLWD重新设计，评估干预的可接受性和参与度。我们 将在一个由80个中心组成的集群中单独测试CPTI的有效性，并与其他干预措施结合使用 社区居住区PLWD的随机、多因素嵌入性实用临床试验及其护理 通过分析急诊率、住院率和在家的总天数来体验急诊率的合作伙伴 在一次索引ED访问之后。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。这项研究完成后，将解决 忽视了接受急诊护理的PLWD从急诊到家庭的过渡。通过严格调查CPTI，我们将 提供关键证据，说明如何改善PLWD的健康结果并实现未得到充分利用的医疗保健 为这一弱势群体提供资源。

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.