Scalable Digital Communication Intervention to Support Older Adults and Care-partners Transitioning Home After Major Surgery

项目摘要 在这份R 01提案中，我们概述了一份全面的5年研究提案，该提案将支持开发和严格的 测试一种可扩展的干预措施，以改善老年人原则与老年人手术护理的整合， 目标是改善患者和护理伙伴的生活质量， 手术这一重要的创新计划旨在改善这一高风险患者群体的护理过渡，因为他们 在大手术后出院回家背景：外科医生试图准备和支持老年人通过 围手术期过渡到医院和回家，与变量的成功。大多数外科医生都没有完全的能力 满足日益增多的需要外科治疗的老年人的需要。解决 老年人在考虑手术时优先考虑的健康结果是改善外科手术的重要机会。 通过开发新的干预措施，提高不断增长的患者群体的护理质量。具体目标和研究 设计：我们的目标是开发myPOSH的第一个版本，这是一种数字干预，旨在改善老年患者的护理 接受手术，包括制定内容和应用程序，以及通过1） 采访接受大手术的老年人及其护理伙伴（n=30）（目标1.1）， 通过来自2）关键临床利益相关者焦点组（即，外科医生、老年病学家和护士）（n=4;至少 24名临床医生）（目标1.2）。接下来，我们会透过公开试验计划，研究myPOSH的初步可行性和接受程度 （n=20例患者，n=2个临床试验机构的2个手术团队）进行离职面谈和前后评估。myPOSH将被完善 (Aim 2）。最后，我们将比较myPOSH与常规手术治疗的可行性和可接受性（n=84例患者; 42 患者/组）。这些发现将告知一个混合动力汽车 通过未来的资金进行有效性试验，并计划将这项工作扩展到其他外科诊所。相关性：此R 01在 根据这项资金公告的目标，开发可扩展的干预措施，以改善护理过渡， 高危患者人群。影响：随着外科系统专业知识的变化，我们认识到 需要提高老年人手术后回家的手术护理质量。通过以下方面取得的经验： 这项建议是未来研究的基础，以改善护理人员的准备和减少病人的焦虑， 围手术期设置。

PROJECT SUMMARY In this R01 proposal, we outline a comprehensive 5-year research proposal that will support development and rigorous testing of a scalable intervention to improve integration of geriatric principles into surgical care of older adults with the goal of improving patient and care-partner quality of life from transitions into and out of the hospital around the time of surgery. This significant and innovative plan aims to improve care transitions for this high risk patient population as they are discharged home after major surgery. Background: Surgeons try to prepare and support older adults through the perioperative transitions to the hospital and back home, with variable success. Most surgeons are not fully equipped to address geriatric needs that exist among the rising number of older adults presenting to surgical attention. Addressing health outcomes that older adults prioritize when considering surgery is an important opportunity to improve surgical care quality in this growing patient population through development of novel interventions. Specific aims and research design: We aim to develop the first version of myPOSH, a digital intervention to improve the care of older patients undergoing surgery including development of content and application with methodology for implementation through 1) interviews with older adults undergoing major surgery and their care-partners when available (up to n=30) (Aim 1.1), with additional input from 2) key clinical stakeholder focus groups (i.e., surgeons, geriatricians, and nurses) (n=4; at least 24 clinicians) (Aim 1.2). Next, we will examine the preliminary feasibility and acceptability of myPOSH via an open pilot (n=20 patients, n=2 surgical teams across 2 sites) with exit interviews and pre-post assessments. myPOSH will be refined (Aim 2). Finally, we will examine the feasibility and acceptability of myPOSH versus usual surgical care (n=84 patients; 42 patients per arm) in a pilot RCT following predetermined benchmarks (Aim 3). These findings will inform a hybrid efficacy trial through future funding with plans to extend this work to other surgical clinic sites. Relevance: This R01 is in line with the goal of this funding announcement to develop scalable interventions to improve care transitions among high risk patient populations. Impact: As surgeons with expertise in surgical systems change, we recognize the critical need to improve surgical care quality among older adults transitioning home after surgery. Experiences gained through this proposal are foundational to future research to improve caregiver preparedness and reduce patient anxiety in the perioperative setting.