Tele-Recovery: Engaging Stakeholders to Adapt and Pilot Test a Scalable Transitional Rehabilitation Intervention for Older, Rural ICU Survivors

点击翻译按钮获取中文摘要

ABSTRACT Access to high-quality post-intensive care unit (ICU) recovery services is a major problem for thousands of older Americans living in rural communities who survive critical illness each year. They and their families often experience uncoordinated care, poor health, reduced independence and quality of life, and high ongoing healthcare utilization. Any scalable solution will require the flexibility to address multimorbidity, physical, cogni- tive, and psychological dysfunction, caregiver stress, and end-of-life transitions, all of which are common. To address this problem: (1) The principal investigator will acquire new skills that position her as an independent implementation physician scientist specializing in improving the quality of geriatric critical care in the post-ICU period. She will complete a career development plan including didactic courses, experiential research, and in- tensive transdisciplinary mentoring with her team from geriatric psychiatry, occupational therapy, critical care, and biostatistics. It will equip her with expertise in stakeholder engagement, transitional care, rehabilitation, telehealth, and implementation science; (2) The proposed research will develop and pilot test a scalable, stakeholder-informed, evidence-based ICU recovery intervention called TeleRecovery. In TeleRecovery, a nurse practitioner and occupational therapist will deliver transitional care, family training and support, and skills-based rehabilitation to rural-dwelling older adults, starting at ICU transfer. From discharge until gradua- tion back to primary care, they will partner with home health providers via telehealth to implement the care plan. Instead of developing TeleRecovery de novo, we will use stakeholder engagement to adapt transitional care (Transitional Care Model) and skills-based rehabilitation (Patient-Driven Skills Training) interventions. These interventions have proven success among clinical populations with key similarities to ICU survivors; combining them will comprehensively address rural-dwelling, older ICU survivors’ complex needs. The first step in developing TeleRecovery will be semi-structured interviews and focus groups with a full range of stake- holders – patients, families, hospital- and community-based providers, and healthcare administrators including payers – to identify priorities, barriers, and facilitators in delivering ICU recovery care for older ICU survivors. We will integrate results into a model of care delivery that is patient-centered and improves health-system qual- ity, affordability, and access. Second, we will conduct stakeholder workshops, telehealth software modification, interventionist training, and user testing to apply the model from Aim 1 to develop TeleRecovery for rural, older ICU survivors. Finally, we will conduct a pilot study to evaluate its feasibility and acceptability among rural, older ICU survivors. This research will generate: (1) partnerships among institutional leaders in critical care, home health, healthcare administration and finance, rehabilitation, and telehealth to facilitate further research; (2) a pilot tested TeleRecovery intervention that is ready for testing in a clinical trial; (3) an independent imple- mentation physician scientist capable of seeing TeleRecovery through implementation and dissemination.