Home-based Primary Care for Homebound Seniors: a Randomized Controlled Trial

居家老年人的家庭初级护理：随机对照试验

• 批准号: 9082810
• 负责人: Alex D Federman
• 金额: $ 72.15万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9082810
• 关键词: Accident and Emergency department; Administrator; Adopted; Adoption; Adult; Age; Ambulatory Care; American; Care given by nurses; Caregiver Burden; Caregivers; Caring; Chronic; Chronic Disease; Clinical; Communities; Cost Control; Data; Devices; Effectiveness; Elderly; Emergency department visit; Evaluation; Exclusion; Expenditure; Family; Family member; Fostering; Friends; Future; Health; Health Care Costs; Health Care Research; Health Policy; Health Services Research; Healthcare; Healthcare Systems; Home environment; Hospitalization; House Call; Individual; Institute of Medicine (U.S.); Insurance Carriers; Insurance Claim Review; Intervention; Interview; Knowledge; Left; Medical; Medicare; Medicare/Medicaid; Mental Depression; Methods; Modeling; New York City; Nursing Economics; Observational Study; Outcome; Outpatients; Pain; Patient Care; Patients; Physicians; Policies; Primary Health Care; Process; Prospective Studies; Provider; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Research; Science; Scientific Advances and Accomplishments; Services; Site; Symptoms; Translating; Translations; United States Centers for Medicare and Medicaid Services; Visit; age related; arm; base; care burden; care giving burden; caregiving; chronic care model; cost; design; disorder control; experience; flexibility; health care delivery; health care quality; health care service utilization; health economics; improved outcome; informal caregiver; inner city; innovation; interest; medical attention; meetings; multidisciplinary; older patient; pragmatic trial; prevent; programs; public health relevance; randomized trial; satisfaction; trial design

 DESCRIPTION (provided by applicant): The objective of this study is to evaluate the impact of home-based primary care (HBPC) on outcomes for homebound older adults, including hospitalization and emergency department (ED) visits, quality of life and symptom control, costs of care, and burden of care for their informal caregivers. We will also conduct a mixed methods dissemination and implementation evaluation of HBPC. Over one million seniors in the U.S. have functional limitations that prevent them from receiving office-based primary care (OBPC). As a result, homebound adults typically experience poor disease control, high rates of hospitalization, and large healthcare expenditures resulting for hospitalizations and ED use. Few modes of healthcare delivery designed specifically for the homebound have been studied, but observational data suggest that HBPC could improve outcomes and reduce spending for these highly vulnerable patients. We propose a pragmatic randomized controlled trial of HBPC vs. OBPC for homebound older adults, with 3 Specific Aims: to compare the impact of HBPC and OBPC 1) on hospitalization and ED visit rates, symptom control and quality of life, and satisfaction with care among homebound elders; 2) on caregiving burden among informal caregivers (e.g., family and friends); and 3) on healthcare expenditures for the homebound. We hypothesize that patients in HBPC and their caregivers will have better outcomes compared to OBPC patients. We will recruit 350 homebound adults ≥ 65 years in New York City from outpatient clinical and community- based settings. HBPC will be delivered through Mount Sinai Visiting Doctors or the Chelsea Village House Calls Program. Patients randomized to OBPC will continue to receive care from their usual outpatient primary care provider or will be assigned one within the Mount Sinai healthcare system. We will conduct interviews in English and Spanish at baseline and quarterly thereafter up to 1 year. Medicare and Medicaid claims data will be used to determine healthcare utilization and costs. The study embraces the concepts of a pragmatic trial design to facilitate the translation of study findings for practical clinical, systms, and health policy applications. The study team includes experts in aging related health services research, health economics, health policy, randomized clinical trials, and the medical and nursing care of homebound older adults. The proposed study would be the largest prospective study of homebound older adults and the only randomized trial of HBPC for the homebound. It would fill important knowledge gaps in our understanding of the effects of HBPC for the homebound. The study is consistent with the Institute of Medicine's call for expanded research on comprehensive models of chronic care, including the multidisciplinary management of chronic diseases and the medical home concept.

 描述（由申请人提供）：本研究的目的是评估家庭初级保健 (HBPC) 对居家老年人结局的影响，包括住院和急诊科 (ED) 就诊、生活质量和症状控制、护理成本以及非正式护理人员的护理负担。我们还将对 HBPC 进行混合方法传播和实施评估。美国有超过 100 万老年人存在功能限制，无法接受基于办公室的初级护理 (OBPC)。因此，居家的成年人通常会经历疾病控制不佳、住院率高以及住院和急诊室使用导致的大量医疗支出。很少有研究专门为居家患者设计的医疗保健服务模式，但观察数据表明 HBPC 可以改善这些高度脆弱患者的治疗结果并减少支出。我们建议对居家老年人进行 HBPC 与 OBPC 的实用随机对照试验，有 3 个具体目标： 比较 HBPC 和 OBPC 1) 对居家老年人的住院率和急诊就诊率、症状控制和生活质量以及护理满意度的影响； 2) 非正式照顾者（例如家人和朋友）的照顾负担； 3）居家者的医疗保健支出。我们假设 HBPC 患者及其护理人员比 OBPC 患者会有更好的结果。我们将从门诊临床和社区环境中招募 350 名纽约市 65 岁以上居家成年人。 HBPC 将通过西奈山访问医生或切尔西村上门服务计划提供。随机分配至 OBPC 的患者将继续接受其通常的门诊初级保健提供者的护理，或者将被分配到西奈山医疗保健系统内的一位。我们将在基线时和此后每季度以英语和西班牙语进行访谈，直至一年。医疗保险和医疗补助索赔数据将用于确定医疗保健利用率和成本。该研究采用务实的试验设计概念，以促进研究结果转化为实际的临床、系统和卫生政策应用。研究团队包括老龄化相关健康服务研究、健康经济学、健康政策、随机临床试验以及居家老年人医疗和护理方面的专家。拟议的研究将是针对居家老年人的最大的前瞻性研究，也是针对居家老年人的 HBPC 的唯一随机试验。它将填补我们理解 HBPC 对居家隔离影响的重要知识空白。该研究符合医学研究所的呼吁，即扩大对慢性病护理综合模式的研究，包括慢性病的多学科管理和医疗之家概念。