FACE-PC: Family-Centered Care for Older Adults with Multiple Chronic Conditions in Primary Care

描述(由申请人提供)：这是一份修订后的研究科学家职业发展指导奖(K01)申请书，题为“Face-PC：初级保健中以家庭为中心的老年抑郁症和慢性病护理”。候选人朴美容博士是匹兹堡大学护理学院的终身教职助理教授。她的职业目标是(1)改善患有多种医疗和心理社会并存的老年人的护理质量，以及(2)成为一名独立研究员，在“现实世界”卫生保健环境中进行的比较有效性试验方面具有专业知识。老年人同时患有抑郁症和多种疾病是一个严重的公共卫生问题。作为与健康有关的活动的重要促进者，家庭已经参与到 老年人慢性病自我管理的各个方面。尽管它们提供了好处，但非正式的护理活动目前是在医疗系统之外组织的，这可能会造成重复或不协调的努力。Park博士的研究以患者和家庭为目标，旨在优化患者及其家人自我管理慢性病的集体能力。家庭的定义是亲属和非亲属的非正式照顾者。她的导师是查尔斯·F·雷诺兹博士(初级导师)，精神病学教授，NIMH赞助的老年抑郁症干预和服务研究高级中心(ACISR)(P30 MH090333)和匹兹堡大学UPMC老年服务研究所的主任，以及Kathryn R.Puskar博士(共同导师)，护理学教授，循证心理社会干预传播和实施方面的专家。这款K01有两个培训目标。目标1是在“真实世界”卫生保健环境中开发和测试以家庭为中心的保健计划方面的专业知识。为了实现这一目标，朴博士计划 关于将质量改进方法作为改进干预措施的一种方法的实践培训(目标1a)和进行务实的临床试验(目标1b)。目标2是了解传播和实施科学的方法，特别强调实施干预措施。指导研究的目的是检验Face-PC的可行性和可接受性，Face-PC是一种理论驱动、多组件、技术辅助的跨学科团队护理模式，系统地让家庭参与慢性病管理。它旨在优化患者和家属自我管理慢性病的集体能力。我们将首先完善研究方案，采用快速循环质量改进方法(目标1)。然后，我们将使用实用临床试验设计和定性方法的混合方法(目标2)对Face-PC进行试点测试。三个分目标是审查可行性和可接受性(目标2a)；确定是否有证据证明假设的定向效应(目标2b)；以及通过面对面的离职面谈获得参与者使用面对面PC的经验(目标2c)。同时，我们将探讨后续R01(目标3)研究方法的可行性。

DESCRIPTION (provided by applicant): This is a revised application for a Mentored Research Scientist Career Development Award (K01) entitled "FACE-PC: Family-Centered Care for Older Adults with Depression and Chronic Medical Conditions in Primary Care." Dr. Mijung Park, the candidate, is a tenure-track Assistant Professor at the University of Pittsburgh, School of Nursing. Her career goals are to (1) improve the quality of care for older adults with multiple medical and psychosocial comorbidities and (2) become an independent researcher with expertise in comparative effectiveness trials conducted in "real-world" health care settings. Comorbid depression and multiple medical conditions in older adults are a serious public health problem. As an important facilitator of health-related activities, families are already involved in various aspects of self-management of chronic disease in older adults. Despite the benefits they provide, informal caregiving activities currently are organized outside the medical system, which potentially creates redundant or misaligned efforts. Dr. Park's research targets patient- family dyads to optimize patients and their families' collective ability to self-manage chronic disease. Family is defined as kin and non-kin informal caregivers. Her mentors are Dr. Charles F. Reynolds III (primary mentor), Professor of Psychiatry, and the director of the NIMH-sponsored Advanced Center for Interventions and Services Research for Late-life Depression (ACISR) (P30 MH090333) and the Aging Institute of UPMC Senior Services and University of Pittsburgh and Dr. Kathryn R. Puskar (co-mentor), Professor of Nursing and an expert in dissemination and implementation of evidence-based psychosocial intervention. This K01 features two training objectives. Objective 1 is to attain expertise in developing and testing family-centered care program in the context of "real-world" health care settings. To meet this objective, Dr. Park plans on gaining hands-on training in quality improvement approaches as a method for intervention refinement (Objective 1a) and in conducting pragmatic clinical trials (Objective 1b). Objective 2 is to learn about approaches in dissemination and implementation sciences, with specific emphasis on implementing intervention. The purpose of the mentored research is to examine the feasibility and acceptability of the FACE-PC, a theory-driven, multi- component, technology-assisted interdisciplinary team-based care model that systematically involves family in chronic disease management. It aims to optimize the patient and family's collective ability to self-manage chronic disease. We will first refine the study protocol, using rapid cycle quality improvement approaches (Aim 1). We will then pilot test FACE-PC using mixed-methods of pragmatic clinical trial design and qualitative methodology (Aim 2). The three sub-Aims are to examine the feasibility and acceptability (Aim 2a); determine if there is evidence of the hypothesized directional effect (Aim 2b); and elicit participants' experience with FACE- PC via face-to-face exit interviews (Aim 2c). Concurrently, we will explore the feasibility of the researc methods for the subsequent R01 (Aim 3).