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GAPcare II: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

GAPcare II：老年急性病

基本信息

批准号：
9812352
负责人：
Elizabeth Goldberg
金额：
$ 24.11万
依托单位：
RHODE ISLAND HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9812352
关键词：
Accelerometer Accident and Emergency department Accreditation Acute Address Age Aging Apple watch Award Caregivers Caring Clinical Trials Communication Data Data Analyses Death Rate Devices Elderly Emergency Care Emergency Department patient Emergency Medicine Emergency department visit Epidemiologist Epidemiology Evaluation Failure Fall prevention Future Gait Goals Health Health Care Costs Health Policy Health Services Health Services Research Healthy People 2020 Home environment Impaired cognition Injury Intervention Intervention Studies Investigation Leadership Life Measures Medication Management Mentors Mentorship Methodology Methods Modeling Modification Monitor Morbidity - disease rate Outcome Outpatients Participant Patient Self-Report Patients Pattern Periodicity Persons Pharmaceutical Preparations Pharmacists Pharmacy facility Physicians Physiological Pilot Projects Policies Population Preparation Prevention Protocols Preventive Intervention Principal Investigator Process Measure Protocols documentation Proxy Public Health Qualitative Methods Qualitative Research Randomized Controlled Trials Recommendation Recurrence Rehabilitation therapy Research Research Personnel Resources Risk Factors Safety Sampling Scientist Series Specialist Standardization Technology Telephone Testing Time Training Work base care coordination care providers career collaborative approach digital disability experience fall risk falls field study fitness follow-up health care service utilization high risk modifiable risk mortality multidisciplinary physical therapist prevent programs recruit response retention rate sensor treatment as usual uptake usability wearable device

项目摘要

PROJECT SUMMARY Falls by older adults are often predictable and preventable, yet there is a notable lack of research evaluating interventions to reduce the occurrence of recurrent falls in older adult Emergency Department (ED) patients. Dr. Goldberg’s Beeson K76 project GAPcare II, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, addresses this lack of research by further refining and examining the intervention she created in her GEMSSTAR R03 project. In this intervention, patients, caregivers, physical therapists (PTs), pharmacy specialists, and clinicians provide a patient-centric, collaborative approach to fall prevention that bridges the ED visit with outpatient resources. PTs evaluate geriatric patients in the ED immediately after their fall, perform a focused assessment of future fall risk and determine the safety of discharge home. Pharmacists in the ED perform a medication therapy management session aimed at reducing/tapering fall risk increasing medication. ED clinicians, patients and caregivers in turn incorporate the advice offered by these professionals before the patient leaves the ED. In her Beeson K76 GAPcare II project, Dr. Goldberg will build on the lessons learned from the GEMSSTAR R03 work. GAPcare II’s specific aims are to: (1) conduct field testing with geriatric patients with and without cognitive impairment and their caregivers to assess the feasibility, acceptability, and usability of the Apple Watch to objectively measure fall-related outcomes; (2) refine the GAPcare intervention and study protocol based on lessons learned and findings from the GEMSSTAR R03 GAPcare I pilot study and conduct a small open trial of the GAPcare II intervention; and (3) conduct a pilot randomized, controlled trial (RCT) of the GAPcare II (n=200) intervention to obtain initial estimates of efficacy of GAPcare II to decrease recurrent falls at 12 months relative to usual care. This investigation will provide Dr. Goldberg with critical pilot data and expertise to submit a R01 proposal to NIA for a full-scale, multi-center, comprehensive RCT. Dr. Goldberg’s Beeson K76 award overarching aims are to develop and test an ED-based and post-discharge protocol that reduces recurrent falls in older adults and to launch her physician-scientist career as an emerging leader in geriatric emergency medicine. To achieve this goal, Dr. Goldberg will obtain additional training in qualitative research, digital health, longitudinal data analysis, clinical trial methods, and leadership. This expertise will be achieved through advanced coursework, leadership training, and intensive interactions with her mentorship team. Her primary mentors, Dr. Roland Merchant, emergency medicine physician and epidemiologist, and Dr. Vincent Mor, health services researcher and health policy expert, will provide training in epidemiology, health services research, and leading policy initiatives. Her mentorship team also includes experts in qualitative research, digital health, rehabilitation measures, longitudinal data analysis, clinical trial methods, fall prevention and geriatric medication management.

项目总结老年人的跌倒通常是可以预测和预防的，但明显缺乏评估的研究减少老年急诊科患者复发性跌倒的干预措施。 Goldberg博士的Beeson K76项目GAPcare II，老年急性和急性后护理协调计划对于急诊部的跌倒预防，通过进一步细化和检查她在GEMSSTAR R03项目中创建的干预。在这次干预中，患者，护理员、物理治疗师(PTS)、药房专家和临床医生提供以患者为中心的、协作预防跌倒的方法，将急诊室就诊与门诊资源联系起来。PTS评估急症室的老年患者在跌倒后立即进行有针对性的未来跌倒风险评估，并确定出院回家的安全性。急诊室的药剂师进行药物治疗管理旨在减少/减少跌倒风险的会议增加了用药。急诊科临床医生、患者和护理人员在患者离开急诊室之前，将这些专业人士提供的建议纳入其中。在她的Beeson K76 GAPcare II项目中，Goldberg博士将建立在从GEMSSTAR学到的经验教训上 R03工作。GAPcare II的具体目标是：(1)对有和没有老年患者进行现场测试认知障碍及其照顾者评估苹果的可行性、可接受性和可用性观察以客观衡量与跌倒相关的结果；(2)完善GAPcare干预和研究方案基于从GEMSSTAR R03 GAPCARE I试点研究中吸取的经验教训和发现，并进行了一项小规模 GAPCARE II干预的开放试验；以及(3)进行试点随机对照试验(RCT) GAPcare II(n=200)干预以获得GAPcare II减少复发性跌倒疗效的初步估计与通常的护理相比，只有12个月。这项调查将为戈德伯格博士提供关键的试点数据和专业人士向NIA提交R01提案，以进行全面、多中心、全面的RCT。 Goldberg博士的Beeson K76奖的首要目标是开发和测试基于ED的和出院后减少老年人反复跌倒的方案，并开始她的医生-科学家职业生涯作为一个新兴老年急救医学领域的领军人物。为了实现这一目标，戈德伯格博士将接受额外的培训定性研究、数字健康、纵向数据分析、临床试验方法和领导力。这专业知识将通过高级课程、领导力培训和与她的导师团队。她的主要导师，罗兰·梅钱特博士，急诊内科医生和流行病学家，以及卫生服务研究员和卫生政策专家文森特·莫尔博士将提供培训在流行病学、卫生服务研究和领导政策倡议方面。她的导师团队还包括定性研究、数字健康、康复措施、纵向数据分析、临床试验方面的专家方法：预防跌倒和老年用药管理。