READI-SET-GO: Researching Efficient Approaches to Delirium Identification - Sustaining Effective Translation to create Gero-friendly Organizations

READI-SET-GO摘要 谵妄对老年人及其护理伙伴有毁灭性的影响。它与住院有关 不良事件（例如，福尔斯），身体和认知功能下降，养老院安置和增加 mortality.尽管结果不佳且成本高，但< 50%的谵妄病例在常规护理中被发现。 为了应对这一挑战，在READI（研究谵妄识别的有效方法）中，我们 开发、验证和现场测试了超简短CAM（UB-CAM），这是一种两步谵妄识别方案 它结合了超简短的2项屏幕（UB-2）和经过验证的诊断工具（3D-CAM）。共录取527人 平均患者数年龄80岁，35% ADRD，在2家研究医院进行了参考标准谵妄 在924个住院日（153个伴谵妄）进行评估，随后进行盲态UB-CAM App指导评估 由医生、注册护士和注册护士助理组成。UB-CAM是可行的（97%完成 率），简短（平均1分15秒），总体准确率为89%，并在所有学科中表现良好。我们 在患有阿尔茨海默病的READI参与者的丰富子集中发现了类似的阳性结果， 阿尔茨海默病相关性痴呆（AD/ADRD）。我们同时进行了定性研究， 了解实施谵妄筛查的障碍和促进因素。虽然READI实质上 尽管该研究在该领域取得了进展，但它没有在所有住院的老年人中全面实施筛查。 我们现在建议在READI-SET-GO（READI-Sustaining Effective Translation to 创建老年友好组织），将每日谵妄筛查（使用UB-CAM）纳入常规护理 在2个州3家医院的6个急症医疗/外科单位，每一个老年人都需要支付医疗费用。我们将进行 阶梯楔形实施设计，其中UB-CAM筛选将每6 在为期42个月的研究中。我们将利用基于证据的实施策略和测试保真度， 准确性、可持续性和影响力。使用一个由2万名老年人组成的实用队列，加上一个嵌套的病人- 针对1050名AD/ADRD富集老年人的定向样本，我们提出以下具体目标， 1.测试整合日常护士谵妄筛查的真实性、准确性和可持续性 将UB-CAM用于所有住院老年人的常规护理。 2.评价UB-CAM谵妄筛查对以患者和护理伙伴为中心的 在一个月的随访访谈中评估护理的结果和看法。 3.评价UB-CAM筛查对谵妄并发症（福尔斯、血压）发生率的影响 损伤、吸入）和不良谵妄管理（精神活性药物、约束使用）。 从拟议的研究结果将很容易被采用到临床护理，并将直接告知最好的 谵妄筛查的做法，特别是对易受伤害的老年人与AD/ADRD。我们的结果 有可能使医院成为老年人更安全的地方，改善结果并减少痛苦。

ABSTRACT for READI-SET-GO Delirium has a devastating impact on older adults and their care partners. It is associated with in hospital adverse events (e.g., falls), declines in physical and cognitive function, nursing home placement and increased mortality. Despite its poor outcomes and high costs, < 50% of all delirium cases are detected in routine care. To address this challenge, in READI (Researching Efficient Approaches to Delirium Identification) we developed, validated, and field tested the Ultra-brief CAM (UB-CAM), a two-step delirium identification protocol that combines an ultra-brief 2-item screen (UB-2) with a validated diagnostic tool (3D-CAM). We enrolled 527 patients, avg. age 80 years, 35% with ADRD, at 2 study hospitals, performed reference standard delirium evaluations on 924 hospital days (153 with delirium), followed by blinded UB-CAM App-directed assessments by physicians, registered nurses, and certified nursing assistants. The UB-CAM was feasible (97% completion rate), brief (average 1 min 15 seconds), had overall accuracy of 89%, and performed well by all disciplines. We found similar positive results in the enriched subset of READI participants with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD). We simultaneously conducted qualitative research to understand barriers and facilitators to implementation of delirium screening. While READI substantially advanced the field, it did not test full scale implementation of screening among all hospitalized older adults. We now propose to take this critical next step in READI-SET-GO (READI—Sustaining Effective Translation to create Gero-Friendly Organizations) by integrating daily delirium screening using the UB-CAM into routine care for every older adult admitted to 6 acute medical/surgical units at 3 hospitals in 2 states. We will conduct a stepped-wedge implementation design, where UB-CAM screening will be launched at a new unit every 6 months over a 42-month study. We will utilize evidence-based implementation strategies and test fidelity, accuracy, sustainability, and impact. Using a pragmatic cohort of 20,000 older adults, plus a nested patient- oriented sample of 1050 older adults enriched for AD/ADRD, we propose the following Specific Aims, 1. To test the fidelity, accuracy, and sustainability of integrating daily nurse screening for delirium using the UB-CAM into routine care for all hospitalized older adults. 2. To evaluate the impact of UB-CAM delirium screening on patient and care partner centered outcomes and perceptions of care assessed at one month follow-up interviews. 3. To evaluate the impact of UB-CAM screening on rates of delirium complications (falls, pressure injury, aspiration) and adverse delirium management (psychoactive medication, restraint use). Findings from the proposed study will be readily adopted into clinical care and will directly inform best practices for delirium screening, particularly for vulnerable older individuals with AD/ADRD. Our results have the potential to make the hospital a safer place for older adults, improving outcomes and reducing distress.