Nursing Home Prevention of Injury in Dementia (NH PRIDE)

摘要： 对于疗养院(NH)的居民来说，伤害性跌倒是常见的、病态的和昂贵的，特别是那些患有 阿尔茨海默病和相关痴呆(ADRD)。我们的长期目标是减少NH的伤害性跌倒 居民。目前的提案将制定伤害利亚森服务(ILS)干预措施，旨在促进 取消精神活性药物和心脏代谢药物的处方，鼓励治疗骨质疏松症。这个 干预措施将解决NH研究中遇到的预防跌倒的常见障碍，包括支离破碎的 沟通。提出了以下具体目标：1)开发ILS护理模式，旨在预防 在NH居民中使用a)自动风险计算器来识别高风险居民的伤害跌落，b)集中 由受伤联络护士进行护理协调，以及c)与NH工作人员举行视频会议；2)测试ILS 在有和没有ADRD的居民中的四个保健设施的实施效果；和3)制定 ILS模型在2-3个NH链中进行第二阶段疗效试验的方案和资源。中心假设是 ILS模式将通过通过取消处方和增加护理提供来减少伤害性跌倒 骨质疏松症治疗。我们假设ADRD患者的实施障碍更大，并且 这将需要反复的干预修改，以实现在这一人群中的坚持。我们将使用 目标1中基于经验的联合设计原则，召集关键利益相关者，以改造 对单一的、务实的护理模式的干预可以在NH系统中传播。在目标2中， 我们将在四个保健机构实施护理模式。这将需要对预测模型进行编程 在急救中心内识别高危居民。一名集中的ILS护士将实施停药 偏远地区高危居民(n~80)骨质疏松治疗的建议。 将使用视频会议来促进教育和交流。我们将衡量执行情况 成功使用可接受性、需求性、忠诚度和实用性的岗位干预措施。有效性将 使用事前设计的流程措施(例如，减少用药剂量)进行测量，以及安全性 将使用最小数据集(MDS)的事后衡量标准和分层图表审查进行评估 按ADRD状态。此外，我们将验证计划的初步结果，用于未来的务实试验，伤害 从MDS中确定的跌倒情况，并附有图表审查。在目标3中，我们将制定方案和所有材料 用于在2-3条NH链内进行ILS的嵌入式实用临床试验。研究团队 在NH研究方面有相当丰富的经验，包括实施科学。在完成这项工作后 通过研究，我们将开发出一种健壮的护理模型，该模型可由NH系统轻松部署并进行评估 因为它对ADRD居民的伤害性跌倒造成影响。我们将处于进行务实临床研究的理想位置 试验嵌入NH系统，以测试ILS的效果。除了解决伤害性跌倒问题外，这一点 模型有可能被修改用于患有ADRD的NH居民的其他复杂的老年综合征。

Abstract: Injurious falls are common, morbid, and costly for nursing home (NH) residents, particularly those with Alzheimer’s Disease and Related Dementias (ADRD). Our long-term goal is to reduce injurious falls in NH residents. The current proposal will develop an Injury Liason Service (ILS) intervention designed to promote deprescribing of psychoactive and cardiometabolic drugs AND encourage osteoporosis treatment. The intervention will address common barriers to fall prevention encountered in NH studies including fragmented communication. The following specific aims are proposed: 1) Develop an ILS care model designed to prevent injurious falls in NH residents using a) an automated risk calculator to identify high risk residents, b) centralized care coordination by an Injury Liaison Nurse, and c) videoconferencing with NH staff; 2) Test the ILS’ implementation-effectiveness in four NH facilities in residents with and without ADRD; and 3) Develop the protocol and resources for a phase 2 efficacy trial of the ILS model in 2-3 NH chains. The central hypothesis is that the ILS model will reduce injurious falls by changing care delivery through deprescribing and increased osteoporosis treatment. We hypothesize that implementation barriers are greater for residents with ADRD, and that it will require iterative intervention modifications to achieve adherence in this population. We will use experience-based co-design principles in Aim 1 to convene key stakeholders to transform the components of the intervention into a single, pragmatic care model that could be disseminated across NH systems. In Aim 2, we will implement the care model in four NH facilities. This will require programming the prediction model within the EMRs to identify high risk residents. A centralized ILS nurse will enact deprescribing recommendations and osteoporosis treatment among high risk residents (n~80) from a remote location. Videoconferencing will be used to facilitate education and communication. We will measure implementation success using post intervention measures of acceptability, demand, fidelity, and practicality. Effectiveness will be measured using process measures (e.g., medication dose reduction) using a pre-post design, and safety will be assessed using both pre-post measures from the Minimum Data Set (MDS) and chart review, stratified by ADRD status. In addition, we will validate the planned primary outcome for a future pragmatic trial, injurious falls ascertained from the MDS, with chart review. In Aim 3, we will develop the protocol and all materials needed for conducting an embedded pragmatic clinical trial of the ILS within 2-3 NH chains. The research team has considerable experience with NH research, including implementation science. At the completion of this study, we will have developed a robust care model that can be readily deployed by NH systems and evaluated for its impact on injurious falls in ADRD residents. We will be ideally positioned to conduct a pragmatic clinical trial embedded in NH systems to test the efficacy of the ILS. In addition to addressing injurious falls, this model has the potential to be modified for other complex geriatric syndromes in NH residents with ADRD.