Bridging Communication Gaps between Primary Care Providers and Adult Day Service Centers to Reduce Emergency Department Use and Hospitalizations among Persons with Dementia

项目摘要 阿尔茨海默病和阿尔茨海默病相关痴呆（AD/ADRD）社区居民 比其他人更容易受到可避免的急诊科（艾德）就诊和住院治疗的影响。 机构设置。成人日间服务中心（ADC）为越来越多的儿童提供社区护理。 患有AD/ADRD的高危成人。艺发局的跨学科研究人员每天进行评估和连续观察， 工作人员支持及早发现慢性病患者健康状况的不利变化。然而，在这方面， 当使用者的健康状况发生急剧变化时， 为了促进早期干预，护理提供者（PCP）常常不能有效地这样做。数量 到2050年，AD/ADRD患者的人数预计将增加两倍，其中大多数仍留在社区， 需要加强ADC和PCP之间重要临床信息的沟通，以减少 昂贵的住院和艾德就诊。移动的健康（mhealth）干预措施可以改善医疗保健社区 通过消除各种环境中实时双向信息交换的障碍来改进流程。 然而，我们先前发现艺发局职员依赖传真或语音留言， 血压或使用者行为的急剧变化，导致PCP延迟或无反应。这 让小健康问题升级为医疗紧急情况。拟议的混合方法的目的 在电子健康增强慢性病护理模式（eCCM）的指导下，连续的解释性研究将告知 开发未来低成本的移动的应用程序，促进跨学科的通信， ADC和PCP围绕AD/ADRD ADC使用者不良健康结局的关键风险因素。以下 具体目标是：（1）确定与艾德就诊和住院相关的健康和社会风险因素; AD/ADRD患者ADC使用者在一年内的生活情况;（2）探索障碍和促进因素 ADC工作人员与PCP之间围绕与艾德访视相关的风险因素进行有意义的沟通， AD/ADRD患者的住院情况;（3）确定未来移动健康干预的关键领域， 支持ADC和PCP之间围绕与艾德访视和hos相关的风险因素进行沟通， 在AD/ADRD患者中的pitizations。在目标3中，我们将目标1和目标2的发现锚在移动健康中 一个框架，在概念上映射未来mhealth干预的关键领域，将支持生产性com， PCP和ADC之间围绕艾德就诊和住院患者的风险因素进行的沟通 AD/ADRD。这项研究意义重大，因为改善社区提供者之间的沟通可以 支持早期临床干预，提高护理标准，并阻止昂贵的不良后果， AD/ADRD患者的弱势亚群。这项研究是创新的，因为它结合了大规模的数据， AD/ADRD患者的健康和社会需求及其护理提供者的观点， 开发迫切需要的实用的移动医疗解决方案，将社区环境中的护理整合起来。

PROJECT SUMMARY Community-dwelling persons with Alzheimer’s Disease and Alzheimer’s disease-related dementias (AD/ADRD) are more susceptible to avoidable emergency department (ED) visits and hospitalizations than individuals in institutional settings. Adult day service centers (ADCs) provide community-based care to a growing number of highly vulnerable adults with AD/ADRD. Daily assessment and serial observations by the ADC’s interdisciplinary staff support early detection of adverse changes in health status in people with chronic conditions. However, when acute changes in users’ health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) in order to facilitate early intervention, frequently cannot do so effectively. As the number of persons with AD/ADRD is expected to triple by 2050 and most remain in the community, there is a critical need to strengthen communication of salient clinical information between ADCs and PCPs in order to reduce costly hospitalizations and ED visits. Mobile health (mhealth) interventions can improve healthcare communica- tion processes by eliminating barriers to real-time bidirectional information exchange across a variety of settings. Yet, we previously found that ADC staff relied on facsimile or voicemail message to communicate abnormal blood pressures or acute changes in users’ behavior, resulting in a delayed or non-response from the PCP. This allowed minor health issues to escalate into medical emergencies. The objective of the proposed mixed-methods sequential explanatory study, guided by the ehealth Enhanced Chronic Care Model (eCCM), is to inform the development of a future low-cost mobile application that facilitates transdisciplinary communication between ADCs and PCPs around key risk factors for poor health outcomes in ADC users with AD/ADRD. The following are the specific aims: (1) Determine health and social risk factors that are associated with ED visits and hospi- talizations among ADC users living with AD/ADRD over a one-year period; (2) Explore barriers and facilitators of meaningful communication between ADC staff and PCPs around risk factors associated with ED visits and hospitalizations in persons with AD/ADRD; (3) Identify the key domains of a future mhealth intervention that supports communication between ADCs and PCPs surrounding risk factors associated with ED visits and hos- pitalizations in persons with AD/ADRD. In Aim 3, we anchor the findings from Aims 1 and 2 within an mhealth framework to conceptually to map key domains of a future mhealth intervention that will support productive com- munication between PCPs and ADCs around risk factors for ED visits and hospitalizations in persons with AD/ADRD. This study is significant because improved communication across community-based providers can support early clinical intervention, improve standards of care, and thwart costly adverse outcomes for a highly vulnerable subset of persons with AD/ADRD. This study is innovative because it combines large-scale data on the health and social needs of persons with AD/ADRD with the perspectives of their care providers to inform the development of urgently needed pragmatic mhealth solutions that integrate care across community settings.