Improving Palliative Care Access Through Technology (ImPAcTT): A Multi-Component Pilot Study

项目摘要 K76应用程序将支持斯蒂芬斯博士继续发展成为一个变革性的 老龄化和姑息治疗研究的跨学科领导者，他检查并促进了 医疗保健系统的连接点，以改善获得姑息治疗服务的机会，并为难以接触到的人提供支持 养老院（Nursing Home）。比森学者计划对她迄今为止的成功至关重要， 最重要的是，她有能力确保这一高度竞争性的大学教授职位， 犹他州。她组建了一支优秀的多学科导师和科学顾问团队， 包括来自犹他州大学的教师导师/顾问。她的团队拥有以下领域的专业知识： 临床老年病学和姑息治疗（里奇、李、苏皮亚诺博士）;实施科学（里奇、李博士）; 为年老体弱者提供综合护理的模式（里奇、艾灵顿、布拉纳根博士）;衡量和改善 NHS的医疗质量（Lee、哈灵顿、Ouslander博士）;制定/评估以患者为中心的 技术，如远程保健，用于改善对医学上复杂的老年人的护理（里奇博士， Branagan）;临床试验设计和复杂数据集分析的统计专业知识（Sheng博士）;长期 护理卫生政策（哈灵顿博士）;转化定性研究方法（Shim博士）;开发，测试 和评估NH环境中的多组分干预（Ouslander博士）。 沟通欠佳，无法及时获得适当的姑息治疗专业知识和支持 在NH环境中，通常会导致繁重的过渡，特别是在生命结束时。斯蒂芬斯博士的研究 将侧重于开发、优化和试点测试一个由多个组成部分组成的“通过技术改善获取”方案 （ImPAcTT）干预措施，利用现有的远程保健技术提供工作人员教育;家庭 外展、参与和支持;护理协调;居民症状管理和促进 护理目标的讨论ImPAcTT采用安全的通信平台，允许多人实时 视频、音频和短信咨询;实时文档共享和高级文档 护理规划讨论;以及远程虚拟评估能力。在目标1中，她将进行半- 与NH工作人员，居民和家庭进行结构化访谈，以探索使用的潜在障碍和促进因素 远程医疗，以增加对PC专业知识，支持和教育的上游访问。在目标2中，她将评估 远程医疗提供NH姑息治疗教育和支持的技术可行性，并开发和 与多达10名NH居民，家庭和工作人员完善研究方案。在目标3中，她将引导一个飞行员 在4家医院进行实施试验，以评估多组分ImPAcTT的可行性和可接受性 干预这些研究将为R 01应用提供科学基础， 多中心临床试验中ImPAcTT干预的结果。

PROJECT SUMMARY This K76 application will support Dr. Stephens’ continued progression to become a transformative interdisciplinary leader in aging and palliative care research who examines and promotes changes at the junctures of healthcare systems to improve access to palliative care services and supports for hard to reach nursing home (NH) populations. The Beeson Scholars program has been critical to her successes to date, but most importantly to her ability to secure this highly competitive endowed professor position at the University of Utah. She has assembled an excellent multidisciplinary team of mentors and scientific advisors which now includes faculty mentors/advisors from the University of Utah. Her team has the following areas of expertise: clinical geriatrics and palliative care (Drs. Ritchie, Lee, Supiano); implementation science (Dr. Ritchie, Lee); integrated care delivery models for frail elders (Drs. Ritchie, Ellington, Branagan); measuring and improving health care quality in NHs (Drs. Lee, Harrington, Ouslander); developing/evaluating patient-centered technologies, such as telehealth, for improving care for medically complex older adults (Drs. Ritchie, Branagan); statistical expertise on clinical trial design and analysis of complex datasets (Dr. Sheng); long term care health policy (Dr. Harrington); translational qualitative research methods (Dr. Shim); developing, testing and evaluating multi-component interventions in the NH setting (Dr. Ouslander). Suboptimal communication and lack of access to appropriate and timely palliative care expertise and support in the NH setting often leads to burdensome transitions, particularly at the end of life. Dr. Stephens’ research will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion. ImPAcTT employs a secure communications platform that permits multi-person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities. In Aim 1, she will conduct semi- structured interviews with NH staff, residents and families to explore potential barriers and facilitators to using telehealth for increasing upstream access to PC expertise, support, and education. In Aim 2, she will assess the technical feasibility of telehealth to provide NH palliative care education and support, and develop and refine study protocols with up to 10 NH residents, families and staff. In Aim 3, she will conduct a pilot implementation trial in 4 NHs to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention. These studies will provide the scientific foundation for a compelling R01 application to evaluate the outcomes of this ImPAcTT intervention in a multi-site clinical trial.