GAPcare: The Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department

项目总结 跌倒是老年人急诊科就诊的主要伤害相关原因，两者都是 可预防和可预测的，但典型的急诊室评估仅侧重于伤害评估。GAPcare，The 急诊科老年急诊及急诊后预防跌倒护理协调计划， 是一项向教育署呈交的预防老年人复发性跌倒的早期研究。参与者 在这项研究中，将有成年人(65岁)摔倒并送到急诊室护理。我们会随机 将参与者分配到干预组或日常护理组。在干预臂物理治疗师(PTS)中， 药剂师和急诊医生合作确定患者跌倒的原因并解决任何已确定的问题 风险因素。高年级学生将带着一份标准化的清单回国，清单中包含了他们评估的细节和 一个锻炼计划。这些参与者被推荐到相同的PT组进行门诊体检或职业检查 治疗，以提供持续的护理。一般护理组的参加者会接受教育署提供的照顾。 仅限内科医生。我们的长期目标是预防老年人的早期发病率和死亡率 摔了一跤后去了急诊室。这次调查的总体目标是收集有关可行性的初步数据， 初步疗效，并征求对GAPcare干预的反馈，以进一步完善我们对 后续研究。核心假设是GAPcare将通过消除风险因素和 为患者提供改善功能的工具。理由是，教育署的访问是一个可以教育的时刻，在这个时刻， 患者和护理人员都很投入，专家之间的合作是可能的。老年人有很多 在出院后获得及时和全面的秋季评估的障碍。我们将致力于以下工作 具体目的是测试和进一步完善GAPCARE干预措施：(1)审查招募和 将符合条件的患者保留到GAPcare干预中，(2)确定GAPcare的初步疗效 干预以减少随后的下降和6个月后的医疗保健利用率。这将通知效果大小 和样本量计算，用于后续研究，以及(3)征求医生和患者对 他们对GAPCARE干预措施的满意度。这项调查预计将有两个主要方面 贡献：1.我们将收集有关可行性、初步疗效的信息，并征求对 GAPcare干预，这将帮助我们改进后续研究的方法和2.Goldberg博士将 接受培训和初步数据，以将更大规模的研究作为K奖提交给国家研究所 衰老。这种干预的公共卫生意义是巨大的，因为跌倒是致命和 老年人中的非致命性伤害，并且没有协作护理模式来指导急诊管理员和 其他利益相关者，以减少后续跌倒的发生。这项建议具有很高的创新性，因为 与其他以社区为基础的计划不同，在此期间，它针对的是ED中最高风险的老年人 在跌倒后，病人最容易反复跌倒，并高度投入护理。

PROJECT SUMMARY Falls are the leading injury-related cause of Emergency Department (ED) visits in older adults and are both preventable and predictable, but the typical ED evaluation focuses on an injury assessment only. GAPcare, the Geriatric Acute & Post-acute Care Coordination Program for Fall Prevention in the Emergency Department, is an early stage investigation for preventing recurrent falls in older adults that present to the ED. Participants in this study will be adults ( 65 years old) who had a fall and present to the ED for care. We will randomly assign participants to an intervention or usual care arm. In the intervention arm physical therapists (PTs), pharmacists, and the ED physician collaborate to identify reasons the patient fell and address any identified risk factors. Seniors will return home with a standardized checklist containing details of their assessment and an exercise plan. These participants are referred to the same PT group for outpatient physical or occupational therapy, to provide continuity of care. Participants in the usual care arm receive care as provided by the ED physician only. Our long-term goal is to prevent the early morbidity and mortality of older adults who present to the ED after a fall. The overall objective of this investigation is to gather preliminary data on the feasibility, initial efficacy, and to solicit feedback on the GAPcare intervention to further refine our approach for the subsequent study. The central hypothesis is that GAPcare will lead to fewer falls by eliminating risk factors and giving patients tools for improving function. The rationale is that the ED visit is a teachable moment, in which patients and caregivers are engaged and collaboration of specialists is possible. Older adults have many barriers to accessing timely and comprehensive fall evaluations after discharge. We will pursue the following specific aims to test and further refine the GAPcare intervention: (1) Examine the feasibility of recruitment and retention of eligible patients into the GAPcare intervention, (2) determine the initial efficacy of the GAPcare intervention in reducing subsequent falls and healthcare utilization at 6 months. This will inform the effect size and sample size calculations for the subsequent study, and (3) solicit feedback from physicians and patients on their satisfaction with the GAPcare intervention. This investigation is expected to have two major contributions: 1. We will gather information on the feasibility, initial efficacy, and solicit feedback on the GAPcare intervention, which will help refine our approach for the subsequent study and 2. Dr. Goldberg will receive the training and preliminary data to submit a larger study as a K award to the National Institute on Aging. The public health significance of this intervention is immense as falls are the leading cause of fatal and non-fatal injury in older adults and no model of collaborative care exists to direct ED administrators and other stakeholders to reduce the occurrence of subsequent falls. This proposal is highly innovative because unlike other community-based programs it targets the most high-risk seniors in the ED during the period immediately after a fall when patients are most vulnerable for repeat falls and highly engaged in their care.