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

摘要 获得高质量的重症监护室（ICU）后恢复服务是数千名患者的主要问题。 生活在农村社区的美国老年人每年都能从重病中幸存下来。他们和他们的家人经常 经历不协调的护理，健康状况不佳，独立性和生活质量下降， 保健利用。任何可扩展的解决方案都需要灵活性，以解决多形态、物理、认知、 积极的，心理功能障碍，照顾者的压力，和生命结束的过渡，所有这些都是常见的。到 解决这个问题：（1）主要研究者将获得新的技能，使她成为独立的研究者。 实施医生科学家专门提高老年重症监护室后的质量 期她将完成一个职业发展计划，包括教学课程，经验研究，并在- 与她的团队进行了紧张的跨学科指导，包括老年精神病学，职业治疗，重症监护， 和生物统计学。这将使她具备利益相关者参与、过渡期护理、康复、 远程医疗和实施科学;（2）拟议的研究将开发和试点测试一个可扩展的， 患者知情的，基于证据的ICU恢复干预称为TeleRecovery。在TeleRecovery中， 执业护士和职业治疗师将提供过渡性护理、家庭培训和支持， 从转入重症监护病房开始，向居住在农村的老年人提供基于技能的康复服务。从出院到毕业- 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护理 计划我们将利用利益相关者的参与来适应过渡，而不是重新开发TeleRecovery。 护理（过渡护理模式）和基于技能的康复（患者驱动的技能培训）干预措施。 这些干预措施已在与ICU幸存者有关键相似性的临床人群中证明是成功的; 将它们结合起来将全面解决农村居住的老年重症监护室幸存者的复杂需求。第一 开发TeleRecovery步骤将是半结构化访谈和具有全方位利害关系的焦点小组， 持有人-患者、家庭、医院和社区提供者以及医疗保健管理人员，包括 付款人-确定优先事项，障碍，并提供ICU康复护理老年ICU幸存者的促进者。 我们将把结果整合到以病人为中心的医疗服务模式中，提高卫生系统的质量。 城市、可负担性和可获得性。其次，我们将举办利益相关者研讨会，远程医疗软件修改， 干预培训和用户测试，以应用目标1的模式，为农村、老年人和残疾人开发远程康复服务。 重症监护室的幸存者最后，我们将进行一项试验性研究，以评估其在农村、 重症监护室的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， 家庭保健、保健管理和财务、康复和远程保健，以促进进一步的研究; (2)一个试点测试的远程恢复干预，准备在临床试验中测试;（3）一个独立的实施， 通过实施和传播，能够看到TeleRecovery的心理医生科学家。

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.