Development and Assessment of Diagnostic Accuracy of a Telemedicine-Based Delirium Assessment Tool (The Tele-CAM)

项目总结 该项目的总体目标是开发和建立远程医疗的诊断准确性- 基于精神错乱评估工具的TELE-CAM。 精神错乱是一种认知和注意力的急剧变化，与各种不良后果有关。 包括住院死亡率增加，长期类似痴呆症的认知能力下降，以及风险增加 为了使之制度化。妄想症在术后人群中很普遍，并且患病率随着 年龄。奥斯汀博士和他的研究团队最近进行的研究表明，许多受试者 带着严重的精神错乱出院回家。因活动性精神错乱出院到护理机构的患者情况更糟 结果比非神志不清的患者要好。尽管在急性后护理中已知精神错乱的负面影响 机构人群中，对持续性精神错乱对术后功能恢复的影响知之甚少 放回原处。目前的临床诊断需要面对面的接触，这是 限制了在出院后环境中可行地进行频繁精神错乱评估的能力。 在过去的几年里，支持视频会议的设备，如智能手机，已经成为 司空见惯。与此同时，人们对远程医疗和认知障碍的远程诊断的兴趣也在增长。 由于正在进行的新冠肺炎大流行，这种兴趣变得更加强烈。我们假设 目前可用的视频会议功能可以轻松、快速地用于执行可靠的精神错乱 在家庭环境中对老年人的评估。该项目将改进和评估诊断的准确性 一种基于CAM的远程医疗精神错乱评估工具(TELE-CAM)，可用于 家庭环境和远程研究人员的评估。 我们提出了一项前瞻性队列研究，该研究将开发和改进这一工具，并展示 进行家庭精神错乱评估的可行性(目标1)。我们还将确定诊断的准确性 将我们的远程精神错乱评估工具与参考标准面对面评估进行比较(目标2)。 我们将招募400名年龄较大的参与者，要么因急性疾病住院，要么因此接受大手术 项目。对研究人员来说，进行室内精神错乱评估的能力将被证明是无价的。 主动性精神错乱患者出院与留院的适宜性比较 他们的神志不清。此外，它将为临床医生提供一种快速、远程精神错乱的方法 评估他们的病人。

PROJECT SUMMARY The overarching objective of this project is to develop and establish the diagnostic accuracy of a telemedicine- based delirium assessment tool, the TELE-CAM. Delirium, an acute change in cognition and attention is associated with a variety of undesirable outcomes including increased in-hospital mortality, long-term cognitive decline that mimics dementia, and increased risk for institutionalization. Delirium is prevalent in the post-operative population, and prevalence increases with age. Recent work performed by Dr. Austin and his research team demonstrated that many subjects were discharged home with active delirium. Patients discharged with active delirium to a nursing facility have worse outcomes than non-delirious patients. Despite the known negative effects of delirium in the post-acute care institution population, little is known about the impact of persistent delirium on functional recovery after discharge to the home setting. Current clinical diagnosis of delirium requires a face-to-face encounter, which limits the ability to feasibly perform frequent delirium assessments in the post-discharge setting. Over the past few years, devices that support videoconferencing, such as smart phones, have become commonplace. Concurrently, interest in telemedicine and remote diagnoses of cognitive disorders has grown. This interest has become even more acute due to the ongoing COVID-19 pandemic. We hypothesize that currently available videoconferencing capabilities can be easily and quickly utilized to perform reliable delirium assessments in older adults in the home setting. This project will refine and assess the diagnostic accuracy of a telemedicine-based delirium assessment tool based on the CAM (the TELE-CAM) that can be utilized in the home setting and assessed by remote researchers. We propose a prospective cohort study that will develop and refine this tool as well as demonstrate the feasibility of conducting in-home delirium assessments (Aim 1). We will also establish the diagnostic accuracy of our remote delirium assessment tool compared to a reference standard face-to-face assessment (Aim 2). We will enroll 400 older participants either hospitalized for an acute medical problem or major surgery for this project. The ability to perform in-home delirium assessments will prove invaluable to researchers investigating the appropriateness of discharging actively delirious patients’ home versus keeping them in the hospital until resolution of their delirium. Further, it will provide a method for clinicians to perform quick, remote delirium assessments of their patients.