Integration of Geriatric Care into Dialysis Clinics

项目总结/文摘

PROJECT SUMMARY/ABSTRACT Older dialysis patients commonly have geriatric syndromes which contribute to increased healthcare utilization and poor quality of life. Currently, identification and management of geriatric syndromes are not included in dialysis care. Adding geriatric syndrome management into routine care for dialysis patients could result in significant improvements in quality of life and healthcare utilization. Barriers to integration of geriatric evaluation and management into dialysis clinics (e.g., time, personnel, costs) can be minimized through the development of innovative geriatric care models that leverage the existing dialysis unit interprofessional team and workflow. We will pilot a new dialysis care model that includes a centralized geriatric team that uses information from the Geriatric screen for OLder Dialysis patients (GOLD) to develop individualized recommendations for geriatric syndrome management based on the patient’s priorities. The GOLD is a self-administered screening battery of validated instruments to screen for a range of geriatric syndromes (cognitive impairment, depression, falls, mobility disability, social support needs, and malnutrition). The multidisciplinary dialysis team will integrate the recommendations into their care plans with support from the centralized geriatric team. Ultimately, this geriatric care model could be seamlessly integrated into dialysis clinic structure. The objective of this application is to optimize the care model with key stakeholder input and conduct a pilot randomized controlled trial (RCT) to obtain evidence critical to inform a definitive RCT. We propose three aims: 1) iteratively refine GOLD to achieve acceptable agreement with a geriatrician evaluation, 2) iteratively refine the geriatric care model to ensure acceptability and feasibility to key stakeholders, and 3) conduct a pilot RCT (n=100) to evaluate the geriatric care model’s impact on geriatric syndrome management and inform design of a larger RCT. For Aim 1, we will have participants complete the GOLD and undergo geriatric evaluation. We will assess agreement of each GOLD instrument with its corresponding geriatric evaluation, and if target agreement is not achieved, we will iteratively modify and re-test the GOLD instrument. For Aim 2, we will refine the care model using experience-based co- design with a stakeholder advisory board and multiple phases of feedback from study participants. After patients complete the care model, these patients and their dialysis clinicians will assess acceptability and feasibility of the care model through surveys and interviews. The care model will be iteratively refined until specific metrics of success are achieved. For Aim 3, patients will be randomized to receive the geriatric care model or usual care; geriatric syndrome management measured by patient report and chart abstraction will be compared at 3 months. We will also assess patient reported outcomes, physical function, and health care utilization at intervals up to 12 months to assess their adequacy for inclusion as outcomes in a subsequent definitive RCT. Upon completion, we will have key preliminary data for a large RCT testing a novel dialysis geriatric care model. Overall, this application will address the significant problem of geriatric syndromes in the older dialysis population.