Placing patient preferences at the center of care plans for older adults transitioning from the hospital to a skilled nursing facility

将患者偏好置于老年人从医院过渡到熟练护理机构的护理计划的中心

• 批准号: 10620352
• 负责人: James David Harrison
• 金额: $ 13.2万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620352
• 关键词: Adopted; Aging; American; Behavior; California; Caregivers; Caring; Clinical; Collaborations; Communication; Communities; Creativeness; Data; Elderly; Elements; Ensure; Ethnography; Family; Foundations; Future; Geriatrics; Goals; Health care facility; Health system; Home; Hospitalization; Hospitals; Impairment; Individual; Institutional Practice; Intervention; Interview; Learning; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Outcome; Participant; Patient Discharge; Patient Preferences; Patient-Focused Outcomes; Patients; Perception; Pharmaceutical Preparations; Phase; Preparation; Process; Prospective Studies; Provider; Qualitative Research; Recovery; Research; Research Methodology; Research Personnel; San Francisco; Scientist; Series; Skilled Nursing Facilities; Techniques; Testing; Time; Training; Trust; Universities; Vision; Voice; Work; acceptability and feasibility; aspirate; care delivery; career; design; expectation; experience; health communication; hospital readmission; human centered design; human old age (65+); implementation evaluation; implementation outcomes; implementation science; implementation strategy; implementation tool; improved; improved outcome; innovation; leadership development; patient engagement; patient oriented; person centered; pilot test; post implementation; preference; professor; programs; provider communication; research and development; satisfaction; skills; theories; therapy development; tool; user centered design

PROJECT SUMMARY / ABSTRACT This is an application for a K01 Award for Dr. James Harrison, an Assistant Professor at the University of California San Francisco. Dr. Harrison’s career goal is to become an independent researcher in aging who uses patient engagement and implementation science to improve the outcomes of older adults transitioning from the hospital to skilled nursing facilities (SNFs). Dr. Harrison’s aspiration is for health systems to place older adults at the center of innovation discovery and care redesign. This K01 Award will help make this aspiration a reality by providing him with the training and research experience needed to develop and implement care transition interventions that are patient-centered and sustained in real-world settings. To facilitate successful completion of these activities, Dr. Harrison has assembled a strong mentorship team. His primary mentor is Dr. Margaret Fang, a clinical outcomes researcher who focuses on medications for vulnerable older adults. His co-mentors are Dr Rebecca Sudore, an expert in developing and testing tools to facilitate health communication for diverse older adults; Dr. Audrey Lyndon, an expert in qualitative research methods focusing on communication and teamwork; Dr Andrew Auerbach, an expert implementation scientist. Older adults comprise 75% of all hospital discharges to SNFs each year. Transition care planning remains persistently medicalized, failing to be guided by patients’ own preferences for their recovery, and does not incorporate elements that support preferences related to independence, returning home and function, or factors that allow participation in family or community activities that provide a foundation for personal purpose. An intervention to support patient and provider communication around patient preferences that can guide SNF transition planning is needed. In Aim 1, Dr. Harrison will conduct a qualitative grounded theory study to explore how patients and caregivers anticipate and are prepared for a SNF discharge. This study will also examine care team behaviors and processes that impact on how preferences are incorporated into transition plans. Aim 2 will involve co-developing a SNF preparation tool (SNF-PT) and associated implementation strategy with stakeholders using human centered design techniques. The objective of the SNF-PT will be to facilitate communication and implementation of patient preferences into SNF transition plans. In Aim 3, the SNF-PT will be piloted focusing on implementation outcomes and preliminary impacts on patient outcomes. This data will inform future R01 type-applications evaluating the SNF-PT. Through a focused program of mentored training and coursework, Dr. Harrison will gain skills in 1) Core principles of geriatrics, 2) The theory and application of advanced qualitative research methods (e.g. grounded theory), 3) User-centered design techniques to intervention development for older adults, and 4) Research leadership development. This K01 Award will provide Dr. Harrison with the expertise and data to launch his career as an independent investigator in aging focused on the hospital to SNF care transition.

项目总结/摘要 这是詹姆斯·哈里森博士的K 01奖申请书，他是大学的助理教授。 位于加州旧金山弗朗西斯科。哈里森博士的职业目标是成为一名衰老领域的独立研究人员， 使用患者参与和实施科学来改善老年人过渡的结果 从医院到专业护理机构（SNF）。哈里森博士的愿望是让卫生系统 老年人处于创新发现和护理重新设计的中心。这个K 01奖将有助于使这个 通过为他提供发展和研究所需的培训和研究经验， 实施以患者为中心并在现实环境中持续的护理过渡干预措施。到 为了促进这些活动的成功完成，哈里森博士组建了一个强大的导师团队。他 主要导师是Margaret Fang博士，她是一位临床结果研究员，专注于治疗 脆弱的老年人。他的共同导师是Rebecca Sudore博士，她是开发和测试工具的专家， 促进不同老年人的健康交流;奥黛丽·林登博士，定性研究专家 注重沟通和团队合作的方法;安德鲁奥尔巴赫博士，专家实施科学家。 老年人占每年所有出院到SNF的75%。过渡护理规划 仍然坚持药物治疗，未能以患者自己的康复偏好为指导， 不包含支持与独立、返回家园和功能相关的偏好的元素，或 允许参与家庭或社群活动的因素，为个人目的提供基础。 支持患者和提供者围绕患者偏好进行沟通的干预措施，可以指导SNF 需要进行过渡规划。在目标1中，哈里森博士将进行定性扎根理论研究，以探索 患者和护理人员如何预期和准备SNF出院。本研究还将探讨 护理团队的行为和流程，影响如何将偏好纳入过渡计划。目的 2将涉及共同开发一个SNF准备工具（SNF-PT）和相关的实施战略， 以人为本的设计技术。SNF-PT的目标是促进 将患者偏好传达并实施到SNF过渡计划中。在目标3中，SNF-PT将 试点侧重于实施结果和对患者结果的初步影响。这些数据将 通知未来评估SNF-PT的R 01型应用。 通过一个有针对性的指导培训和课程计划，哈里森博士将获得以下技能： 老年医学原理，2）先进的定性研究方法的理论和应用（如接地 理论），3）以用户为中心的设计技术，以干预老年人的发展，和4）研究 领导力发展。这个K 01奖将为哈里森博士提供专业知识和数据， 职业生涯作为一个独立的调查员在老龄化的重点是医院到SNF护理过渡。

项目成果

Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives.

现代临床学习环境中的学员自主权和监督：教师和学员观点的混合方法研究。

• DOI: 10.21203/rs.3.rs-2982838/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: Conner,StephanieM;Choi,Nancy;Fuller,Jessica;Daya,Sneha;Barish,Peter;Rennke,Stephanie;Harrison,JamesD;Narayana,Sirisha
• 通讯作者: Narayana,Sirisha

Patient Perceptions of e-Visits: Qualitative Study of Older Adults to Inform Health System Implementation.

• DOI: 10.2196/45641
• 发表时间: 2023-05-26
• 期刊: JMIR aging
• 影响因子: 4.9

Earn our trust: The perspectives of patients and caregivers.

• DOI: 10.1002/jhm.12796
• 发表时间: 2022-04
• 期刊: Journal of hospital medicine
• 影响因子: 2.6

Inpatient Understanding of Their Care Team and Receipt of Mixed Messages: a Two-Site Cross-Sectional Study.

• DOI: 10.1007/s11606-023-08178-4
• 发表时间: 2023-09
• 期刊: JOURNAL OF GENERAL INTERNAL MEDICINE
• 影响因子: 5.7
• 作者: Atkinson, Mariam Krikorian;Wazir, Mohammed;Barkoudah, Ebrahim;Khalil, Hassan;Mani, Sampathkumar;Harrison, James D.;Yao-Cohen, Erin;Weiss, Rachel;To, C.;Bambury, Elizabeth A.;Cimino, Jenica;Mora, Rosa;Maru, Johsias;Curatola, Nicole;Juergens, Nathan;Schnipper, Jeffrey L.
• 通讯作者: Schnipper, Jeffrey L.

The current landscape of Acute Care for Elders units in the United States.

• DOI: 10.1111/jgs.17892
• 发表时间: 2022-10
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Rogers, Stephanie E.;Flood, Kellie L.;Kuang, Qiao Yu;Harrison, James D.;Malone, Michael L.;Cremer, Julia;Palmer, Robert M.
• 通讯作者: Palmer, Robert M.