Transforming residential palliative care for persons with dementia through behavioral economics and data science

通过行为经济学和数据科学改变痴呆症患者的住院姑息治疗

• 批准号: 10251982
• 负责人: Scott D Halpern
• 金额: $ 75.37万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10251982
• 关键词: Address; Admission activity; Advance Care Planning; American; Area; Arts; Assisted Living Facilities; Behavior; Behavior Therapy; Behavioral; Benchmarking; Businesses; Caregivers; Caring; Collaborations; Communication; Computers; Conflict (Psychology); Data; Data Science; Dementia; Discipline of Nursing; Disease; Electronic Health Record; Engineering; Faculty; Family; Family Caregiver; Family Nursing; Fostering; Funding; Future; Goals; Grant; Health Policy; Healthcare; Hospitalization; Hospitals; Institution; Intervention; Intervention Studies; Knowledge; Lead; Life; Link; Logistics; Machine Learning; Measures; Mechanical ventilation; Mentors; Methodology; Methods; Modeling; Monitor; Natural Language Processing; Nurses; Nursing Homes; Online Systems; Outcome; Outpatients; Palliative Care; Pathway Analysis; Patient Preferences; Patients; Pennsylvania; Persons; Physicians; Pilot Projects; Positioning Attribute; Pragmatic clinical trial; Process; Qualitative Methods; Research; Research Personnel; Research Support; Resources; Risk; Schools; Science; Scientist; Services; Site; Social Network; Societies; Specialist; Surveys; System; Testing; Translating; United States National Institutes of Health; Universities; Variant; Work; acceptability and feasibility; advanced disease; base; behavior change; behavioral economics; care delivery; care outcomes; care systems; caregiver interventions; cost; dementia care; effective intervention; effectiveness trial; efficacy study; electronic data; end of life; health economics; hospice environment; implementation efforts; implementation science; improved; innovation; insight; medical schools; novel; palliative; peer; person centered; pragmatic trial; provider behavior; social; statistics; success; symptom management; therapy development; tool

The central goal of this proposed Roybal Center is to develop, test, and implement novel interventions that bridge the dramatic gap between the supply of and need for palliative care services among persons with dementia (PWD) living in long-term services and support (LTSS) facilities, as well as their family caregivers. Several innovative aspects of this proposed Center position us to succeed in this challenging but increasingly important space. First, we have assembled a team comprising more 50 investigators and staff from 5 schools within the University of Pennsylvania, and the most accomplished investigators of palliative approaches to care for PWD from 11 peer institutions. These investigators possess content knowledge and tremendous expertise in leading all Stages of behavioral intervention development as defined by the NIH Stage Model. Second, we will support these behavioral scientists by linking them with Center faculty with expertise in several key methodologic areas including behavioral economics, data science, statistics, qualitative methods, health policy and economics, and implementation science. Our focus on translating behavioral economic insights to change the behaviors of clinicians and caregivers involved in the care of PWD builds on our recent success using similar approaches to improve palliative care delivery in outpatient and hospital settings. Our focus on using machine learning, natural language processing, and network methods will enable us to (a) identify mechanisms of clinician behavior that account for aggressive care for PWD, (b) identify PWD with the greatest unmet palliative care needs so as to sustainably target intervention delivery, and (c) more efficiently measure person-centered outcomes in the context of large, pragmatic trials of the most promising interventions. Third, this Center is being launched in partnership with Genesis HealthCare, the nation's largest owner of LTSS facilities, with 401 nursing homes and assisted living facilities across the U.S. These facilities provide ideal settings within which to develop and test interventions that will be effective and sustainable in the real world. Further, by developing and testing the interventions in these settings, while continually increasing our collaborations with other owners of LTSS facilities, we will be ideally positioned to implement effective interventions in the places in which the majority of Americans with dementia are cared for near the end of life. This Center will be directed by a Steering Committee, and will include a Management and Administrative Core housed within Penn's existing Palliative and Advanced Illness Research (PAIR) Center. A Pilot Core will select, guide, and monitor pilot projects chosen for funding each year. We propose two pilots for funding in the first year: a Stage I study that seeks to adapt a web-based advance care planning platform for use among PWD and their caregivers in LTSS settings, and a Stage 0 study that will use data science methods to identify clinician behaviors associated with hospitalization risk among PWD, yielding targets for future interventions.

这个提议的Roybal中心的中心目标是开发、测试和实施新的干预措施， 弥合患者对姑息治疗服务供需之间的巨大差距 居住在长期服务和支持(LTSS)设施中的痴呆症患者及其家庭照顾者。 拟建中心的几个创新方面使我们能够在这一具有挑战性但日益增长的领域取得成功 重要的空间。首先，我们组建了一个由来自5所学校的50多名调查人员和工作人员组成的团队 在宾夕法尼亚大学，以及最有成就的姑息治疗方法的研究人员 来自11个同级机构的残疾人士。这些调查人员拥有丰富的知识和丰富的专业知识。 领导NIH阶段模型定义的行为干预发展的所有阶段。 其次，我们将为这些行为科学家提供支持，将他们与在几个领域拥有专业知识的中心教职员工联系起来 主要方法论领域包括行为经济学、数据科学、统计学、定性方法、健康 政策和经济学，以及实施科学。我们的重点是将行为经济学的见解转化为 改变参与PWD护理的临床医生和照顾者的行为建立在我们最近的成功基础上 使用类似的方法来改善门诊和医院环境中的姑息治疗服务。我们的重点是 使用机器学习、自然语言处理和网络方法将使我们能够(A)识别 临床医生的行为机制，解释了积极的治疗PWD，(B)确定PWD是最大的 未得到满足的姑息治疗需求，以便可持续地瞄准干预提供；和(C)更有效地衡量 在最有希望的干预措施的大型、务实试验的背景下，以人为中心的结果。 第三，该中心是与美国最大的医疗保健公司Genesis Healthcare合作成立的 LTSS设施，在美国各地拥有401家疗养院和辅助生活设施。这些设施提供 开发和测试在现实中有效和可持续的干预措施的理想环境 世界。此外，通过在这些环境中开发和测试干预措施，同时不断增加我们的 与LTSS设施的其他所有者合作，我们将处于实施有效 对大多数美国痴呆症患者在生命接近尾声时得到照顾的地方进行干预。 该中心将由一个指导委员会领导，并将包括一个管理和行政核心 位于宾夕法尼亚州立大学现有的缓解和晚期疾病研究(PATH)中心内。导频核心将选择， 指导和监督每年选定的资助试点项目。我们在第一个项目中提出了两个试点项目 年：我研究的一个阶段，旨在调整一个基于网络的高级护理计划平台，供残疾患者使用 和他们在LTSS环境中的照顾者，以及将使用数据科学方法识别 临床医生的行为与PWD的住院风险相关，为未来的干预提供了目标。