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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：
10001415
负责人：
Elizabeth Goldberg
金额：
$ 23.96万
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/10001415
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 acute care 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.

项目摘要老年人的福尔斯跌倒通常是可以预测和预防的，但明显缺乏评估老年人跌倒的研究。干预措施，以减少老年人急诊科（艾德）患者复发性福尔斯的发生。博士Goldberg的Beeson K76项目GAPcare II，老年急性和急性后护理协调计划在急诊科预防跌倒，解决了这种缺乏研究的进一步完善，检查她在GEMSSTAR R 03项目中创建的干预。在这个过程中，患者，护理人员，物理治疗师（PT），药学专家和临床医生提供了一个以患者为中心，协作方法来预防跌倒，将艾德就诊与门诊资源联系起来。PT评价艾德的老年患者在跌倒后立即进行未来跌倒风险的集中评估，确定出院回家的安全性。艾德的药剂师进行药物治疗管理会议旨在减少/逐渐减少跌倒风险增加药物。艾德临床医生、患者和护理人员在病人离开急诊室之前，把这些专业人员提供的建议结合起来。在她的Beeson K76 GAPcare II项目中，Goldberg博士将借鉴GEMSSTAR的经验教训， R 03工作。GAPcare II的具体目标是：（1）对老年患者进行现场测试，认知障碍和他们的照顾者，以评估苹果的可行性，可接受性和可用性，观察以客观测量跌倒相关结局;（2）完善GAP护理干预和研究方案根据GEMSSTAR R 03 GAPcare I试点研究的经验教训和发现， GAPcare II干预的开放性试验;（3）对GAPcare II干预进行试点随机对照试验（RCT）。 GAPcare II（n=200）干预，以获得GAPcare II减少复发性福尔斯有效性的初步估计与常规护理相比，12个月时。这项调查将为戈德堡博士提供关键的试点数据，向NIA提交R 01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一种基于ED的出院后协议，减少复发福尔斯在老年人，并启动她的医生，科学家的职业生涯作为一个新兴的老年急救医学的领导者为了实现这一目标，戈德堡博士将获得额外的培训，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，罗兰商人博士，急诊医学医生和流行病学家和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，卫生服务研究和领先的政策倡议。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、临床试验专家方法、跌倒预防和老年药物管理。