Development and validation of the Patient-Reported Outcome Measure - Older adult care Transitions from the Emergency Department (PROM-OTED) tool

项目摘要/摘要 65岁及以上的人在急诊科就诊人数超过2200万人次 每年一次。最近在ED评估后减少不必要的住院的努力导致了 大约65%的老年ED患者出院回家。EDI后的这段脆弱时间段 出院具有重要的临床和公共卫生重要性，因为它与增加的 发病和死亡的可能性以及非计划的ED再犯和入院治疗。尽管 在这一过渡时期，不良后果的发生率很高，但人们对这些经历和 老年人在从教育署回国过渡期间面临的具体挑战。对…有清醒的认识 患者在与健康相关的生活质量、功能障碍、沟通障碍和 ED出院后的特定情况症状是告知临床对话和 制定针对老年人护理过渡的干预措施。 该提案的总体目标是使用顺序探索性混合方法来 制定和验证患者报告的结果衡量标准--老年护理从急诊室过渡 (PROM-OOT)工具，一种新的护理过渡PROM，适用于经历ED出院护理的老年人 过渡。我们将通过以下两个目标来实现这一目标：1)开发可编程工具， 确定老年人优先考虑的ED出院护理过渡的结果。我们将使用迭代 定性方法包括概念识别、成员检查概念排名、认知 面谈以开发问题，并通过改进的德尔菲法减少专家小组项目；以及2) 对已启动的工具进行内部有效性测试。我们将进行定量的调查评估 该工具在最近经历过勃起功能障碍的老年人中的初步心理测量特性和可行性 出院护理过渡。 与“国家老龄问题研究所：2020-2025年战略研究方向”相一致， 这项提案的发现将提高我们对老龄化社会的需求的理解，以便为干预提供信息 发展和政策决策。具体地说，这项工作将通过制定一项措施产生重大影响 评估教育署长者优先考虑的成果目前是否已达到，并找出机会 在临床和研究领域的改进。在获奖期间，候选人将获得相关的 技能和受益于有经验的临床医生-具有互补技能集的研究人员的指导。这 调查将作为未来NIA K奖申请的初步工作，符合 候选人在更大的国家ED样本中评估启动的工具的长期目标，包括 那些患有阿尔茨海默病和相关痴呆(ADRD)的人，随后发展为护理过渡 帮助老年人顺利完成ED出院护理过渡的干预措施。

PROJECT SUMMARY / ABSTRACT Persons aged 65 years and older account for over 22 million emergency department (ED) visits annually. Recent efforts to reduce unnecessary hospitalizations following ED evaluation have resulted in approximately 65% of older adult ED patients being discharged home. This vulnerable time period post-ED discharge has significant clinical and public health importance as it has been associated with an increased likelihood of morbidity and mortality as well as unscheduled ED recidivism and hospital admission. Despite high rates of adverse outcomes in this period of transition, little is known regarding the experiences and specific challenges faced by older adults during transitions home from the ED. Having a clear understanding of patients' priorities regarding health-related quality of life, functional disability, communication barriers, and condition-specific symptoms after ED discharge is essential to inform clinical conversations and the development of interventions targeting care transitions for older adults. The overall objective of this proposal is to use a sequential exploratory mixed-methods approach to develop and validate the Patient Reported Outcome Measure - Older adult care Transitions from the ED (PROM-OTED) tool, a novel care transitions PROM for older persons experiencing ED discharge care transitions. We will achieve this objective with the following two aims: 1) To develop the PROM-OTED tool, characterizing outcomes of ED discharge care transitions prioritized by older persons. We will use an iterative qualitative approach including concept identification, member checking for concept ranking, cognitive interviewing for question development, and expert panel item-reduction by a modified Delphi process; and 2) To conduct internal validity testing of the PROM-OTED tool. We will perform quantitative survey evaluation of the tool's initial psychometric properties and feasibility among older persons who recently experienced an ED discharge care transition. In alignment with the “National Institute on Aging: Strategic Directions for Research, 2020-2025”, findings of this proposal will improve our understanding of the needs of an aging society to inform intervention development and policy decisions. Specifically, this work will have significant impact by developing a measure to assess whether outcomes prioritized by older adults in the ED are currently met and identify opportunities for improvement in the clinical and research arenas. During the award period, the candidate will acquire relevant skills and benefit from mentorship by accomplished clinician-researchers with complementary skill sets. This investigation will serve as preliminary work towards a future NIA K award application, in line with the candidate's long-term objectives of assessing the PROM-OTED tool in a larger national ED sample, including those with Alzheimer's disease and related dementias (ADRD), and subsequently developing care transition interventions to help older adults successfully navigate ED discharge care transitions.