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Development and evaluation of a palliative-transitional home health care model

姑息过渡家庭医疗保健模式的开发和评估

基本信息

批准号：
10266826
负责人：
CHRISTINE D JONES
金额：
$ 19.44万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
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/10266826
关键词：
Address Advance Care Planning Area Care given by nurses Caregiver Burden Caregivers Caring Clinical Trials Data Development Discipline of Nursing Documentation Elderly Electronic Health Record Emergency department visit Enrollment Ensure Evaluation Evidence based program Focus Groups Future Goals Grant Health Home Home Care Services Home Health Care Agencies Hospital Nursing Hospitalists Hospitalization Hospitals Intervention Interview Medical Medicare Methods Modeling Non-Hodgkin&apos s Lymphoma Nurses Nursing Homes Outcome Palliative Care Patient Care Patient Discharge Patient Preferences Patients Pharmaceutical Preparations Physical therapy Population Practical, Robust Implementation and Sustainability Model Primary Health Care Qualitative Methods Quality of Care Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Personnel Services Skilled Nursing Facilities Social Workers Structure Supportive care Symptoms Testing Time United States Visiting Nurse Work acceptability and feasibility beneficiary care coordination care delivery care providers contextual factors design effectiveness evaluation experience follow-up health care model health care service health care service utilization hospice environment hospital readmission implementation framework implementation science improved informal caregiver innovation interest medical specialties mortality palliative physical therapist pragmatic trial programs prospective test readmission rates tool user centered design

项目摘要

ABSTRACT The overarching goal of this R21 proposal “Development and Evaluation of a Palliative-Transitional Home Health Care Model” is to engage key stakeholders including hospitalists, primary care providers, home health clinicians (e.g., nurses, physical therapists, social workers), patients, and informal caregivers, to develop, refine, and pilot test a Palliative-Transitional Home Health Care (PT HHC) model to provide enhanced support after discharge for patients with additional palliative and transitional care needs. Patients receiving HHC are older and sicker than patients who are discharged home without HHC, yet current HHC does not assess or address palliative care needs. Care models incorporating palliative care principles have reduced health care utilization and improved the quality of care delivery in hospitals, nursing homes, and skilled nursing facilities. However, care models that incorporate both transitional and palliative care in HHC are lacking. Through this work, we aim to improve care for HHC patients with additional palliative and transitional care needs. The specific aims of this project include: (1) To develop and refine a Palliative-Transitional HHC model through focus groups with clinicians, interviews with patients and caregivers, and expert advisory panel guidance, and (2) To implement and evaluate the acceptability and feasibility of a Palliative-Transitional HHC model. Our investigator team has experience using qualitative and implementation science methods to design, implement, and disseminate interventions. We plan to use the Practical, Robust Implementation and Sustainability Model (PRISM) framework with the embedded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation model to design and evaluate the model. This innovative care model will create a new paradigm for HHC nurses and social workers to engage with patients and caregivers to discuss advance care planning, patient symptoms, and caregiver needs, and to communicate with the primary care provider to request specialty palliative and hospice referrals when needed. This proposal fits well within the topics of interest for NIA described in PA-18-503, including development and evaluation of a new HHC model that incorporates palliative care. We plan to prospectively test the model developed in this grant in a future pragmatic trial to evaluate the effect of the PT HHC model on outcomes including patient symptoms, caregiver burden, advance care planning documentation, emergency department visits, and hospitalizations.

摘要 R21提案的首要目标是“开发和评估一个缓和-过渡的家园” 医疗保健模式“是吸引关键的利益相关者参与，包括住院医生、初级保健提供者、家庭健康临床医生(例如，护士、物理治疗师、社会工作者)、病人和非正式护理人员，以发展、完善和试行缓和-过渡期家庭保健(PT HHC)模式，以提供更强的支持出院后有额外姑息和过渡期护理需要的患者。接受HHC治疗的患者有比没有HHC出院的患者年龄更大、病情更重，但目前的HHC不评估或满足姑息治疗需求。纳入姑息治疗原则的护理模式减少了医疗保健提高了医院、疗养院和熟练护理设施的护理服务质量。然而，在HHC中同时包含过渡性和姑息性护理的护理模式是缺乏的。通过这项工作，我们的目标是通过额外的姑息和过渡护理来改善对HHC患者的护理需要。本项目的具体目标包括：(1)开发和完善缓解-过渡性HHC模型通过临床医生的焦点小组、对患者和护理人员的采访以及专家咨询小组指导，以及(2)实施和评估缓和-过渡性HHC的可接受性和可行性模特。我们的研究团队有使用定性和实施科学方法设计的经验，实施和传播干预措施。我们计划使用实用、健壮的实施和可持续发展模型(PRISM)框架，内嵌RE-AIM(REACH、EVALITY、ADOPTION、实施、维护)评价模型，对模型进行设计和评价。这一创新的护理模式将为HHC护士和社会工作者创造一个新的范式患者和护理人员讨论高级护理计划、患者症状和护理人员需求，并当需要时，与初级保健提供者沟通，请求专科姑息和临终关怀转诊。该提案完全符合PA-18-503中描述的NIA感兴趣的主题，包括开发和纳入姑息治疗的新HHC模式的评估。我们计划对该模型进行前瞻性测试在这笔赠款中开发的未来实用试验，以评估PT HHC模型对结果的影响包括患者症状、照顾者负担、高级护理计划文档、急诊科探视和住院治疗。