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

项目摘要 该项目的首要目标是开发和建立远程医疗的诊断准确性， 基于谵妄评估工具，TELE-CAM。 谵妄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，长期认知能力下降，类似痴呆症， 去收容所谵妄在术后人群中普遍存在，并且患病率随着年龄的增长而增加。 年龄奥斯汀博士和他的研究小组最近的工作表明，许多受试者 精神错乱出院回家患者出院时伴有活动性谵妄， 结果比非谵妄患者。尽管谵妄在急性期后护理中具有已知的负面影响， 机构人群中，很少有人知道持续性谵妄对功能恢复的影响， 出院回家。目前临床诊断谵妄需要面对面的接触， 限制了在出院后环境中进行频繁谵妄评估的能力。 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 平凡与此同时，对远程医疗和认知障碍的远程诊断的兴趣也在增长。 由于2019冠状病毒病疫情持续，该兴趣变得更加强烈。我们假设 当前可用的视频会议能力可以容易且快速地用于执行可靠的谵妄 在家庭环境中对老年人进行评估。该项目将完善和评估诊断的准确性， 基于CAM的远程医学谵妄评估工具（TELE-CAM），可用于 家庭环境和远程研究人员评估。 我们提出了一项前瞻性队列研究，将开发和完善这一工具，以及证明 进行家庭谵妄评估的可行性（目标1）。我们还将建立诊断的准确性 我们的远程谵妄评估工具相比，一个参考标准的面对面评估（目标2）。 我们将招募400名老年参与者，他们要么因急性医疗问题住院，要么为此进行大手术。 项目在家中进行谵妄评估的能力将被证明是非常宝贵的研究人员调查 让活跃的谵妄患者出院回家与让他们留在医院的适当性， 解决他们的精神错乱。此外，它将为临床医生提供一种方法， 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.