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

弥合初级保健提供者和成人日间服务中心之间的沟通差距，以减少痴呆症患者使用急诊室和住院治疗

• 批准号: 10093706
• 负责人: Tina Sadarangani
• 金额: $ 39.63万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10093706
• 关键词: Accident and Emergency department; Acute; Address; Adult; Advocate; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; Automobile Driving; Behavior; Behavior Therapy; Blood Pressure; California; Caregivers; Caring; Chronic; Chronic Disease; Clinical; Communication; Communities; Complex; Data; Data Set; Dementia; Demographic Analyses; Development; Diabetes Mellitus; Early Diagnosis; Early Intervention; Elderly; Emergency department visit; Family; Focus Groups; Future; Goals; Health; Health Status; Health system; Healthcare; Heart Diseases; Hospital Costs; Hospitalization; Hospitals; Impaired cognition; Individual; Intervention; Interview; Limited English Proficiency; Maps; Medicaid; Medical Care Team; Medical emergency; Mental Depression; Methods; Minor; Mobile Health Application; Notification; Outcome; Persons; Population Heterogeneity; Positioning Attribute; Process; Provider; Quality of Care; Research; Risk; Risk Factors; Services; Taxonomy; Testing; Time; Work; adverse outcome; base; beneficiary; care providers; chronic care model; clinical care; clinically relevant; community based care; community setting; cost; data standards; design; eHealth; experience; facsimile; health care delivery; health care service utilization; health literacy; improved; innovation; large scale data; mHealth; member; mobile application; multidisciplinary; programs; psychosocial; racial minority; social

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.

项目摘要 患有阿尔茨海默氏病和阿尔茨海默氏病与疾病相关的痴呆症的社区居民（AD/ADRD） 比在 机构环境。成人日服务中心（ADC）为越来越多的社区提供基于社区的护理 高度脆弱的成年人AD/ADRD。 ADC跨学科的每日评估和序列观察 员工支持早期发现患有慢性病患者健康状况的不良变化。然而， 当用户健康状况发生急性变化时，希望及时通知主要通知的ADC员工 护理提供者（PCP）为了促进早期干预，经常无法有效地进行干预。作为数字 预计到2050年有AD/ADRD的人将三倍，并且大多数人留在社区中，这是一个关键的 需要加强ADC和PCP之间的显着临床信息的沟通，以减少 昂贵的住院和急诊就诊。移动健康（MHealth）干预措施可以改善医疗保健通讯 - 通过消除各种环境中实时双向信息交换的障碍来实现过程。 但是，我们以前发现ADC员工在传真或语音邮件中退休以传达异常 用户行为的血压或急性变化，导致PCP产生延迟或无反应。这 允许较小的健康问题升级为医疗紧急情况。提议的混合方法的目的 在eHealth增强的慢性护理模型（ECCM）的指导下，顺序剥夺研究是为了告知 开发未来的低成本移动应用程序，该应用程序有助于跨学科交流 ADC和PCP围绕着ADC/ADRD的ADC使用者不良健康结果的关键危险因素。下列 是具体目的：（1）确定与ED访问和医院相关的健康和社会风险因素 - 在一年内拥有广告/ADRD的ADC用户的窃听； （2）探索障碍和促进者 与ED访问相关的风险因素和PCP之间有意义的沟通和PCP之间的沟通 患有AD/ADRD的人住院； （3）确定未来MHealth干预措施的关键领域 支持与ED访问和HOS相关的风险因素的ADC和PCP之间的通信 广告/ADRD的人的命运。在AIM 3中，我们将AIMS 1和2的发现锚定在MHealth中 从概念上绘制未来MHealth干预措施的关键领域的框架 PCP和ADC之间的城市围绕ED访问的风险因素和患有住院的风险因素 广告/adrd。这项研究很重要，因为改善了基于社区的提供者可以 支持早期的临床干预，提高护理标准，并挫败昂贵的不良后果 AD/ADRD的人的脆弱子集。这项研究具有创新性，因为它结合了有关的大规模数据 具有广告/ADRD的人的健康和社会需求以及其护理提供者的观点，以告知 迫切需要的务实的MHealth解决方案的开发，这些解决方案将护理整合到社区环境中。