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A Nursing Home Pragmatic Clinical Trial of APPROACHES (Aligning Patient Preferences: a Role Offering Alzheimer's patient, Caregivers, and Healthcare providers Education and Support)

疗养院实用方法临床试验（调整患者偏好：为阿尔茨海默病患者、护理人员和医疗保健提供者提供教育和支持的角色）

基本信息

批准号：
10250086
负责人：
SUSAN E HICKMAN
金额：
$ 56.4万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-30 至 2024-08-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY A significant number of patients Alzheimer's disease or related dementia diagnoses will be cared for in nursing homes near the end of life. Unfortunately, many of these patients experience unwanted and burdensome medical treatments, such as potentially avoidable hospitalizations, that negatively impact quality of life. Advance care planning (ACP) discussions with patients and family caregivers are important to explore goals in advance of a crisis and support informed, values-based decision-making. The ACP process helps ensure that preferences about treatments such as hospitalization are known, documented, and honored. Research indicates that ACP can reduce burdensome treatments and increase the likelihood that care will match documented preferences. Nursing homes are currently required by regulations to offer ACP to patients and families. However, there are no training requirements for nursing home staff and approaches to fulfilling this regulatory and ethical responsibility vary widely, resulting in inconsistent ACP. The “Aligning Patient Preferences – a Role Offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES)” trial will test the ACP Specialist Program. Existing nursing home staff members will be trained to enhance care and reduce unwanted, burdensome hospitalizations through improved ACP procedures, standardized staff education on ACP, and systematic ACP facilitation. The primary trial outcome is hospital transfers (admissions and emergency department visits) per 1000 person-days alive. Consistent with the spirit of a pragmatic trial, study outcomes rely on data already collected for quality improvement, clinical or billing purposes. In the 18 month R21 pilot phase, the aims are to: 1) Establish the trial's organizational structure and processes; and 2) Pilot test the intervention in 4 nursing homes. In the R33 phase, a pragmatic cluster randomized clinical trial will be conducted in partnership with 3 nursing home corporations who operate a combined total of 206 diverse urban and rural facilities in 14 states. The aims of the 42 month R33 phase are to: 3) Evaluate the primary outcome of hospital transfers over 12 months among patients with dementia in intervention versus control nursing homes; and 4) Compare ACP documentation, measures of quality of care at the end of life, and patient and family satisfaction between the intervention versus control nursing homes. If successful, the ACP Specialist Program will be primed for rapid translation into nursing home practice to reduce unwanted, burdensome hospitalizations and improve quality of care for patients with dementia.

项目摘要相当数量的阿尔茨海默病或相关痴呆症诊断的患者将在护理中得到照顾家在生命的尽头。不幸的是，这些患者中的许多人经历了不必要的和负担医疗，如可能避免的住院治疗，对生活质量产生负面影响。与患者和家庭护理人员进行的预先护理计划（ACP）讨论对于探索危机的预防和支持知情的、基于价值观的决策。ACP过程有助于确保关于诸如住院的治疗的偏好是已知的、有文件记录的并且被尊重。研究表明ACP可以减少繁重的治疗，并增加护理匹配的可能性记录的偏好。目前，法规要求疗养院向患者提供ACP，家庭然而，对养老院工作人员没有培训要求，也没有实现这一要求的方法。监管和道德责任差异很大，导致ACP不一致。“调整患者” 偏好-一个角色提供阿尔茨海默氏症患者，照顾者，和医疗保健提供者教育和支持（方法）”试验将测试ACP专家计划。现有的养老院工作人员将接受培训，通过改进ACP来加强护理并减少不必要的、繁重的住院治疗机场核心计划程序、标准化的员工机场核心计划教育，以及有系统的机场核心计划便利化。主要试验结果是每1000人活日的医院转移（入院和急诊）。符合一个务实的试验精神，研究结果依赖于已经收集的数据，用于质量改进，临床或计费目的。在为期18个月的R21试验阶段，目标是：1）建立试验的组织结构和过程; 2）在4家养老院进行试点测试。在R33阶段，将与3家经营护理之家的公司合作进行一项随机分组临床试验，在14个州共有206个不同的城市和农村设施。42个月R33阶段的目标是目的：3）评估痴呆患者12个月内转院的主要结局，干预与对照疗养院;和4）比较ACP文件，护理质量的措施在生命的尽头，病人和家庭的满意度之间的干预与控制疗养院。如果成功后，ACP专家计划将迅速转化为养老院实践，减少不必要的、负担沉重的住院治疗，提高痴呆症患者的护理质量。