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: 10265509
• 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 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265509
• 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.

项目总结 阿尔茨海默病和阿尔茨海默病相关痴呆社区居民(AD/ADRD) 比个人更容易受到可避免的急诊科(ED)就诊和住院治疗 机构设置。成人日间服务中心(ADC)为越来越多的 患有AD/ADRD的高度脆弱的成年人。艺发局跨界别的日常评估及系列观察 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， 当用户的健康状况发生急剧变化时，希望及时通知主要工作人员的ADC工作人员 护理提供者(PCP)为了促进早期干预，往往无法有效做到这一点。作为数字 到2050年，AD/ADRD患者的比例预计将增加两倍，大多数人仍留在社区，关键是 需要加强ADC和PCP之间重要临床信息的沟通，以减少 昂贵的住院和急诊科就诊费用。移动医疗(MHealth)干预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，实现信息共享流程。 然而，我们之前发现ADC工作人员依赖传真或语音信箱消息进行异常通信 血压或用户行为的急性变化，导致PCP延迟或无反应。这 允许小的健康问题升级为医疗紧急情况。建议的混合方法的目标 在电子健康增强型慢性护理模式(ECCM)的指导下，顺序解释性研究将向 开发未来的低成本移动应用程序，以促进跨学科的交流 在患有AD/ADRD的ADC用户中，ADC和PCP围绕导致不良健康结局的关键风险因素进行研究。以下是 具体目标是：(1)确定与急诊科就诊和住院有关的健康和社会风险因素- 对患有AD/ADRD的ADC用户进行为期一年的总结；(2)探索障碍和促进者 就与急症室探访有关的风险因素，在艺发局员工和专科医生之间进行有意义的沟通 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ED访问和托管相关的风险因素进行沟通- AD/ADRD患者的脑垂体病变。在目标3中，我们将目标1和目标2的结果固定在mHealth中 从概念上映射未来移动健康干预的关键领域的框架，该框架将支持生产性组件- 儿科医生和疾病预防控制中心对急诊科就诊和住院危险因素的沟通 AD/ADRD。这项研究意义重大，因为改善基于社区的提供商之间的沟通可以 支持早期临床干预，提高护理标准，并阻止高度 AD/ADRD患者中的弱势群体。这项研究具有创新性，因为它结合了 AD/ADRD患者的健康和社会需求与其护理提供者的观点相结合，以告知 开发迫切需要的实用mHealth解决方案，将跨社区环境的护理整合在一起。