A Novel Method for Measuring Goal-Concordant Care in Seriously Ill Older Adults with Multiple Chronic Conditions

一种测量患有多种慢性病的重病老年人的目标一致护理的新方法

• 批准号: 10624780
• 负责人: Isaac Shin Chua
• 金额: $ 19.38万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10624780
• 关键词: Address; Advance Care Planning; Affect; Appointment; Caring; Clinical; Collection; Data; Development; Documentation; Elderly; Electronic Health Record; Ensure; Face; Family; Family member; Feasibility Studies; Feedback; Focus Groups; Generations; Goals; Grant; Health; Health system; Hospital Mortality; Intensive Care; Interview; Life; Life Expectancy; Literature; Measurable; Measurement; Measures; Medicare; Methodology; Methods; Mission; Natural Language Processing; Outcome; Outcome Measure; Palliative Care; Patient-Centered Care; Patients; Personal Satisfaction; Pilot Projects; Population; Positioning Attribute; Primary Care; Process; Property; Psychometrics; Qualitative Methods; Quality Indicator; Reporting; Research Methodology; Research Personnel; Science; Structure; Surveys; Testing; Time; United States National Institutes of Health; Vulnerable Populations; Work; arm; beneficiary; care delivery; cognitive interview; cognitive testing; design; effectiveness measure; end of life; experience; field study; human old age (65+); implementation measures; implementation science; improved; innovation; interest; loved ones; multiple chronic conditions; novel; patient oriented; point of care; preference; primary care clinic; primary care provider; response; skills; structured data; theories

PROJECT SUMMARY / ABSTRACT Delivering goal-concordant care is considered a key component of high-value care for seriously ill older adults with multiple chronic conditions (MCC); however, no gold standard for measurement exists. The long- term goal of the proposed work is to advance the science of quality measurement among seriously ill older adults with palliative care needs. The overall objective in this application is to develop a psychometrically valid patient-reported experience measure (PREM) that measures goal-concordant care among seriously ill older adults with MCC. The rationale is that a validated PREM measuring goal-concordant care can provide real- time feedback necessary to deliver patient-centered care that meets the dynamic needs of this population, while simultaneously functioning as a quality indicator for palliative care delivery. The proposed work will complete the overall objective through three specific aims: 1) develop an item pool that measures goal- concordant care based on domains of health-related values among seriously ill older adults with MCC; 2) evaluate measurement properties of the item pool and resultant PREM by conducting Item Response Theory analysis and test-retest reliability of field test data; and 3) determine the acceptability, feasibility, and fidelity of PREM implementation in primary care. The first aim establishes the PREM’s content validity and is a multimethod qualitative study consisting of: 1) semi-structured interviews with seriously ill older adults with MCC and their PCPs and 2) content analysis of serious illness conversation documentation in the electronic health record identified using natural language processing. Themes that emerge from this qualitative process will inform item and scale generation and refine the hierarchy of health-related value domains relevant to goal- concordant care. Items will be further developed and refined via focus groups with patients and geriatric palliative care experts to identify relevant content not already covered; cognitive interviews with patients to format the items; and item review by the study team. The second aim will establish the PREM’s reliability and construct validity and consists of field tests of seriously ill older adults with MCC followed by psychometric analyses to develop and evaluate the items comprising the PREM. Under the third aim, 40 seriously ill older adults with MCC will complete the PREM in a primary care clinic over 48 weeks in a single-arm pilot study with a multistage, mixed methods design to evaluate the acceptability, feasibility, and fidelity of PREM implementation. This proposal is innovative because it will develop the first validated PREM that measures goal-concordant care among seriously ill older adults with MCC that can also be used to measure the effectiveness of advanced care planning. This work is highly significant because this PREM transforms goal- concordant care into a measurable and actionable construct by quantifying the patient’s experience of how effectively care processes support the patient’s ability to attain self-concordant goals. Ultimately, this PREM will help establish a quality standard for palliative care delivery for seriously ill older adults with MCC.

项目总结/摘要 提供目标一致的护理被认为是重病老年人高价值护理的关键组成部分 患有多种慢性疾病（MCC）的成年人;然而，没有测量的金标准。很长的- 这项工作的长期目标是促进重病老年人的质量测量科学 需要姑息治疗的成年人。在这个应用程序的总体目标是开发一个心理测量有效 患者报告的经验测量（PREM），用于测量老年重症患者的目标一致性护理 成人MCC其基本原理是，经过验证的PREM测量目标一致的护理可以提供真实的- 提供以患者为中心的护理所需的时间反馈，以满足这一人群的动态需求， 同时作为姑息治疗提供的质量指标。拟议的工作将 通过三个具体目标完成总体目标：1）开发一个衡量目标的项目库- 在患有MCC的重病老年人中基于健康相关价值领域的协调护理; 2） 运用项目反应理论评价项目池的测量特性和PREM结果 现场测试数据的分析和重测信度; 3）确定可接受性，可行性和保真度 在初级保健中实施PREM。第一个目标是建立PREM的内容效度， 多方法定性研究包括：1）对患有重病的老年人进行半结构化访谈， MCC及其PCP和2）电子版中严重疾病对话文档的内容分析 使用自然语言处理识别的健康记录。从这个定性过程中出现的主题 将告知项目和量表生成，并细化与目标相关的健康相关价值领域的层次结构- 和谐的关怀项目将通过与患者和老年人的焦点小组进一步开发和完善， 姑息治疗专家确定尚未涵盖的相关内容;与患者进行认知访谈， 编排项目格式;由研究小组进行项目审查。第二个目标是建立PREM的可靠性， 结构效度，包括对患有MCC的重病老年人进行现场测试，然后进行心理测量 分析，以制定和评估PREM的项目。在第三个目标下，40名重病老年人 MCC成人将在48周的单臂试点研究中在初级保健诊所完成PREM， 多阶段混合方法设计，用于评估PREM的可接受性、可行性和保真度 实施.该提案具有创新性，因为它将开发第一个经过验证的PREM， 在患有MCC的重病老年人中的目标一致性护理，也可用于测量 先进护理计划的有效性。这项工作是非常重要的，因为这个PREM转换目标- 通过量化患者的经验， 有效的护理过程支持患者实现自我和谐目标的能力。最后，这个PREM 这将有助于建立一个质量标准，为患有MCC的重病老年人提供姑息治疗。