Integration of Geriatric Care into Dialysis Clinics

将老年护理纳入透析诊所

• 批准号: 10655156
• 负责人: Rasheeda K Hall
• 金额: $ 81.04万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10655156
• 关键词: Address; Adult; Agreement; Automobile Driving; Blinded; Caregivers; Caring; Clinic; Communities; Control Groups; Data; Development; Dialysis patients; Dialysis procedure; Elderly; Ensure; Evaluation; Feedback; Focus Groups; Future; Geriatric Assessment; Geriatrics; Goals; Guidelines; Health; Hemodialysis; Home; Human Resources; Impaired cognition; Interview; Kidney Diseases; Long-Term Care; Malnutrition; Measures; Medical; Mental Depression; Mind; Mission; Modeling; Names; Oncology; Outcome; Outpatients; Participant; Patient Outcomes Assessments; Patient Self-Report; Patient-Focused Outcomes; Patients; Personal Satisfaction; Pharmaceutical Preparations; Phase; Physical Function; Population; Probability; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Research; Resources; Self Administration; Social support; Source; Structure; Surveys; Syndrome; Testing; Time; Visit; Work; acceptability and feasibility; acute care; aged; cost; design; disability; effectiveness evaluation; experience; falls; health care service utilization; improved; innovation; instrument; model development; multidisciplinary; multiple chronic conditions; novel; patient engagement; personalized care; primary outcome; recruit; response; routine care; screening; standard of care; success; telehealth; treatment as usual

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.

项目摘要/摘要 老年透析患者通常有老年综合征，这有助于增加医疗保健利用 生活质量差。目前，老年综合征的识别和管理不包括在 透析护理。在透析患者的常规护理中增加老年综合征管理可能会导致 生活质量和医疗保健利用率的显著改善。老年医学评价整合的障碍 和管理进入透析诊所（例如，时间、人员、成本）可以通过开发最小化 创新的老年护理模式，利用现有的透析单位跨专业团队和工作流程。 我们将试行一种新的透析护理模式，其中包括一个集中的老年团队， 老年透析患者的老年筛查（GOLD），以制定老年患者的个性化建议 根据患者的优先事项进行综合征管理。GOLD是一种自我管理的筛选电池， 有效的仪器来筛选一系列老年综合征（认知障碍，抑郁，福尔斯， 行动不便、社会支助需要和营养不良）。多学科透析团队将整合 在中央老年医疗队的支持下，将建议纳入其护理计划。最终，这位老年人 护理模式可以无缝地集成到透析诊所结构中。本申请的目的是 在关键利益相关者的投入下优化护理模式，并进行试点随机对照试验（RCT）， 获得决定性RCT的关键证据。我们提出了三个目标：1）迭代地改进GOLD， 与老年医学专家评估的可接受的一致性，2）迭代地完善老年护理模型，以确保 关键利益相关者的可接受性和可行性，以及3）进行试点RCT（n=100），以评估老年护理 模型对老年综合征管理的影响，并为更大规模RCT的设计提供信息。对于目标1，我们将有 参与者完成GOLD并接受老年评估。我们将评估每个GOLD的协议 仪器及其相应的老年评估，如果没有达到目标一致，我们将迭代 修改并重新测试GOLD仪器。对于目标2，我们将使用基于经验的合作来完善护理模式， 与利益相关者咨询委员会和研究参与者的多阶段反馈一起设计。在患者 完成护理模式后，这些患者及其透析临床医生将评估 通过调查和访谈了解护理模式。护理模型将被迭代地细化，直到 取得了成功。对于目标3，患者将随机接受老年护理模式或常规护理; 将在3个月时比较通过患者报告和图表摘要测量的老年综合征管理。 我们还将评估患者报告的结果，身体功能和医疗保健利用率，间隔时间最长为12 个月，以评估其是否足以纳入后续确定性RCT的结局。完成后， 我们将获得一项大型随机对照试验的关键初步数据，以测试一种新型的老年透析护理模式。总的来说，这 应用将解决老年透析人群中老年综合征的重大问题。