Tele-Recovery: Engaging Stakeholders to Adapt and Pilot Test a Scalable Transitional Rehabilitation Intervention for Older, Rural ICU Survivors

远程康复：让利益相关者参与调整和试点测试针对老年农村 ICU 幸存者的可扩展过渡性康复干预措施

• 批准号: 10254248
• 负责人: Leslie Page Scheunemann
• 金额: $ 14.76万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254248
• 关键词: Tele; Recovery; Engaging; Stakeholders; Adapt

ABSTRACT Access to high-quality post-intensive care unit (ICU) recovery services is a major problem for thousands of older Americans living in rural communities who survive critical illness each year. They and their families often experience uncoordinated care, poor health, reduced independence and quality of life, and high ongoing healthcare utilization. Any scalable solution will require the flexibility to address multimorbidity, physical, cogni- tive, and psychological dysfunction, caregiver stress, and end-of-life transitions, all of which are common. To address this problem: (1) The principal investigator will acquire new skills that position her as an independent implementation physician scientist specializing in improving the quality of geriatric critical care in the post-ICU period. She will complete a career development plan including didactic courses, experiential research, and in- tensive transdisciplinary mentoring with her team from geriatric psychiatry, occupational therapy, critical care, and biostatistics. It will equip her with expertise in stakeholder engagement, transitional care, rehabilitation, telehealth, and implementation science; (2) The proposed research will develop and pilot test a scalable, stakeholder-informed, evidence-based ICU recovery intervention called TeleRecovery. In TeleRecovery, a nurse practitioner and occupational therapist will deliver transitional care, family training and support, and skills-based rehabilitation to rural-dwelling older adults, starting at ICU transfer. From discharge until gradua- tion back to primary care, they will partner with home health providers via telehealth to implement the care plan. Instead of developing TeleRecovery de novo, we will use stakeholder engagement to adapt transitional care (Transitional Care Model) and skills-based rehabilitation (Patient-Driven Skills Training) interventions. These interventions have proven success among clinical populations with key similarities to ICU survivors; combining them will comprehensively address rural-dwelling, older ICU survivors’ complex needs. The first step in developing TeleRecovery will be semi-structured interviews and focus groups with a full range of stake- holders – patients, families, hospital- and community-based providers, and healthcare administrators including payers – to identify priorities, barriers, and facilitators in delivering ICU recovery care for older ICU survivors. We will integrate results into a model of care delivery that is patient-centered and improves health-system qual- ity, affordability, and access. Second, we will conduct stakeholder workshops, telehealth software modification, interventionist training, and user testing to apply the model from Aim 1 to develop TeleRecovery for rural, older ICU survivors. Finally, we will conduct a pilot study to evaluate its feasibility and acceptability among rural, older ICU survivors. This research will generate: (1) partnerships among institutional leaders in critical care, home health, healthcare administration and finance, rehabilitation, and telehealth to facilitate further research; (2) a pilot tested TeleRecovery intervention that is ready for testing in a clinical trial; (3) an independent imple- mentation physician scientist capable of seeing TeleRecovery through implementation and dissemination.

摘要 获得高质量的重症监护病房(ICU)康复服务是数千人面临的主要问题 居住在农村社区的老年美国人每年都能幸免于危重疾病。他们和他们的家人经常 经历不协调的护理，健康状况不佳，独立性和生活质量降低，以及高持续 医疗保健利用率。任何可扩展的解决方案都需要灵活性，以解决多种疾病、身体、认知- 易感性、心理障碍、照顾者压力和临终转变，所有这些都很常见。至 解决这个问题：(1)首席调查员将获得新的技能，使她成为一名独立的 实施专门致力于提高ICU后老年重症监护质量的内科科学家 句号。她将完成一项职业发展计划，包括授课课程、经验研究和- 与她的团队从老年精神病学、职业治疗、重症监护、 和生物统计学。它将使她在利益相关者参与、过渡护理、康复、 远程医疗和实施科学；(2)拟议的研究将开发和试运行一种可扩展、 利益相关者知情的、基于证据的ICU恢复干预称为远程恢复。在远程恢复中， 护士从业者和职业治疗师将提供过渡期护理、家庭培训和支持，以及 从ICU转院开始，向农村老年人提供以技能为基础的康复。从退伍到毕业- 回到初级保健，他们将通过远程保健与家庭保健提供者合作实施保健 计划。我们将利用利益相关者的参与来适应过渡，而不是开发新的远程恢复 护理(过渡期护理模式)和以技能为基础的康复(患者驱动的技能培训)干预。 这些干预措施在临床人群中被证明是成功的，与ICU幸存者有关键的相似之处； 将它们结合起来，将全面解决农村居住的老年ICU幸存者的复杂需求。第一 开发TeleRecovery的步骤将是半结构化采访和具有全面利害关系的焦点小组- 持有者-患者、家属、基于医院和社区的提供者以及医疗保健管理人员，包括 付款人-确定为ICU老年幸存者提供ICU康复护理的优先事项、障碍和促进者。 我们将把成果整合到以患者为中心的医疗服务模式中，并提高医疗系统质量。 价格、可负担性和可获得性。第二，我们将举办利益相关者研讨会，远程医疗软件修改， 干预者培训和用户测试，以应用目标1中的模型为农村老年人开发远程恢复 重症监护室的幸存者。最后，我们将进行试点研究，评估其在农村地区的可行性和接受性， 更年长的ICU幸存者。这项研究将产生：(1)重症监护机构领导人之间的伙伴关系， 家庭健康、保健管理和财务、康复和远程保健，以促进进一步的研究； (2)准备在临床试验中测试的飞行员测试的远程恢复干预；(3)独立实施- 能够通过实施和传播来观察远程康复的心理医生科学家。