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

项目总结 在这份R01提案中，我们概述了一个全面的5年研究提案，该提案将支持开发和严格 测试一种可扩展的干预措施，以改善老年原则与老年人外科护理的整合 目标是改善患者和护理伙伴的生活质量，从进入和离开医院的过渡到 做手术。这一重大而创新的计划旨在改善这一高危患者群体的护理过渡，因为他们 在大手术后出院。背景：外科医生试图为老年人做好准备并在 围手术期过渡到医院和家里，成功与否参差不齐。大多数外科医生都没有完全准备好 解决越来越多的老年人接受手术治疗时存在的老年病需求。寻址 老年人在考虑手术时优先考虑的健康结果是改善手术的重要机会 通过开发新的干预措施，提高这一不断增长的患者群体的护理质量。具体目标和研究 设计：我们的目标是开发第一个版本的myPOSH，这是一种数字干预手段，旨在改善老年患者的护理 正在进行手术，包括内容和应用程序的开发，以及实施方法，通过1) 对接受大手术的老年人及其护理伙伴进行访谈(最多30人)(目标1.1)， 来自2)关键临床利益相关者焦点小组(即外科医生、老年医生和护士)的额外投入(n=4；至少 24名临床医生)(目标1.2)。接下来，我们将通过开放试验来检查myPOSH的初步可行性和可接受性 (n=20名患者，n=2个外科团队，分布在2个地点)进行离职面谈和事后评估。我的POSH将被提炼 (目标2)。最后，我们将检查myPOSH与常规手术治疗的可行性和可接受性(n=84例患者；42例 每个手臂的患者)在遵循预定基准的试点随机对照试验中(目标3)。这些发现将为混合动力车提供信息 通过未来的资金进行疗效试验，并计划将这项工作扩展到其他外科诊所地点。相关性：这款R01已进入 与本基金公告的目标一致，即开发可扩展的干预措施，以改善以下人群的护理过渡 高危患者群体。影响：随着拥有外科系统专业知识的外科医生发生变化，我们认识到关键 需要提高手术后过渡到家的老年人的手术护理质量。通过以下途径获得的经验 这项建议是未来研究的基础，以改善照顾者的准备和减少患者的焦虑 围手术期环境。

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.