Implementing Advance Care Planning as a Healthy Aging Activity in Rural Primary Care

项目总结/摘要：项目2（NELSON-BRANTELY） 美国65岁及以上的人口预计将在2060年达到9470万;目前，超过五分之一的人 的老年人居住在美国农村。提前护理计划（ACP）是一个护理过程， 成年人分享他们的价值观，生活目标和对未来医疗保健的选择。非加太集团加强协调， 医疗保健服务与病人的价值观，提高病人和家属的满意度，增加使用姑息治疗， 护理，降低成本。尽管全球一致认为老年人应尽早开始ACP，但ACP通常 发生得太晚或根本没有。目前已采取有效的干预措施，以增加非加太国家，但在以下方面仍存在巨大差距： 将干预转化为日常实践。农村初级保健诊所尤其如此。 该项目试验使用执行促进（IF），以提高农村小学对ACP的接受率。 护理诊所综合框架涉及一套综合的执行战略，以促进采用一种证据- 在这项研究中，ACP。建议研究中的IF策略包括：首先尊重选择 Steps® ACP培训、ACP工具包以及用于持续实施和培训支持的远程指导。的 PrISM核心将协助完善研究程序; CEO核心将协助参与临床研究中心; HSR 确保IRB对研究方案的最终批准。 为在农村初级保健诊所实施ACP制定量身定制的ACP计划（目标1）。 我们将使用实施研究综合框架（CFIR）来确定障碍， 协调员，进行需求评估，并制定一个适合当地情况的机场核心计划， 每个诊所 使用实施ACP的IF描述范围、估计效果、采用和实施 (Aim 2）。本研究试行混合229型协议，评估有效性和实施情况 结果。我们将估计效应量和相关的变异性，描述影响范围，采用， 使用IF实现ACP，并将IF与通常实现（IAU）进行比较。 说明利用综合框架实施机场核心计划（目标3）所产生的成本和收入。 将对确定性试验经济评价所需的要素进行可行性评估。 将通过诊所服务收据库存记录成本，并通过ACP账单代码记录收入。 该项目符合拟议的COBRE的目标，以改善农村人口的健康公平，并将 通过提供新的实施知识，纵向推进实施科学领域 在农村初级保健诊所工作的战略。本研究的结果将提供证据基础， 支持R 01应用程序在更大范围内测试IF策略。最终，这项研究预计将 通过将ACP扩展到医疗服务不足的农村地区并改善早期ACP， 老年人在他们不再能够表达他们的愿望之前。

PROJECT SUMMARY/ABSTRACT: PROJECT 2 (NELSON-BRANTELY) The U.S. population age 65 and over is projected to reach 94.7 million in 2060; presently, more than one-fifth of the nation’s elderly reside in rural America. Advance care planning (ACP) is a process of care that supports adults in sharing their values, life goals, and choices regarding future health care. ACP increases alignment of health care services with patients’ values, improves patient and family satisfaction, increases use of palliative care, and reduces costs. Despite global consensus that ACP should start early for older adults, ACP usually happens too late or not at all. Effective interventions to increase ACP exist, yet an extensive gap remains in translating the intervention into everyday practice. This is particularly true in rural primary care clinics. This project pilots the use of implementation facilitation (IF) for improving the uptake of ACP in rural primary care clinics. IF involves an integrated set of implementation strategies to promote adoption of an evidence- based practice—in this study, ACP. The IF strategies in the proposed study include Respecting Choices First Steps® ACP training, an ACP toolkit, and tele-mentoring for ongoing implementation and training support. The PrISM Core will assist with refining study procedures; the CEO Core with engaging clinic sites; and the HSR Core with securing final IRB approval for the study protocol. Develop a tailored ACP plan for implementing ACP into rural primary care clinics (Aim 1). We will use the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to ACP, conduct a needs assessment, and develop an ACP plan adapted to the local context of each clinic. Characterize the reach, estimated effect, adoption, and implementation using IF for implementing ACP (Aim 2). This study pilots a Hybrid Type 229 protocol, estimating both effectiveness and implementation outcomes. We will estimate effect size and associated variability, describe the reach, adoption, and implementation of ACP using IF, and descriptively compare IF to implementation as usual (IAU). Describe the costs and revenue generated from using IF for implementing ACP (Aim 3). Feasibility assessment of elements necessary for a definitive trial economic evaluation will be conducted. Costs will be captured through a clinic service receipt inventory and revenue through ACP billing codes. The project aligns with the goals of the proposed COBRE to improve health equity for rural populations and will advance the field of implementation science vertically by providing new knowledge of implementation strategies that work in rural primary care clinics. The outcomes of this study will provide an evidence base to support an R01 application testing the IF strategy on a larger scale. Ultimately, this research is expected to have a positive impact by expanding ACP to medically underserved rural areas and improving early ACP for older adults before they are no longer able to make their wishes known.