READI: Researching Efficient Approaches to Delirium Identification

 描述（由申请人提供）：谵妄影响高达50%的住院老年人，并且与功能和认知下降、疗养院安置、死亡率和1640亿美元的美国医疗费用独立相关。尽管有这些令人信服的数字，但对谵妄的认识不足仍然是一个主要问题。在这种情况下，在美国医院实施系统性谵妄识别的兴趣越来越大，然而，关于如何以有效和高效的方式实施此类计划的证据很少。我们的目标是制定一个实用的，有效的，具有成本效益的协议，用于检测和监测谵妄的高风险住院老年人，并产生所需的证据基础，以促进其广泛实施。R 01 AG 030618“3D-CAM：推导和验证谵妄的3分钟诊断评估”的第一轮资助的产品将作为我们方案的关键组成部分。其中包括：1）3D-CAM;可在3分钟内完成的高性能谵妄诊断访谈; 2）可有效排除谵妄的超简短（30-40秒）2项筛选。我们现在建议：1）在2个独立的队列中验证筛选器; 2）将筛选器和3D-CAM联合收割机成2步谵妄识别方案; 3）测量临床医生管理该方案的有效性和成本效益; 4）采用定性方法确定实施该方案的障碍和促进因素。因此，我们的申请“READI：研究谵妄识别的有效方法”具有以下具体目的：目的1）在两个大的现有老年患者队列中独立验证我们的2项超简短筛选器，其中严格执行谵妄评估：1）SAGES：择期手术后的成功衰老，无基线痴呆的手术后样本（N=566），和2）END-DSD：早期护士检测谵妄叠加痴呆症（N=391），急性医院样本，所有人都患有痴呆症。目的2）在一个新的队列中，从一个大型城市学术医疗中心和一个小型农村社区医院招募了400名普通内科患者，以评估由医生和护士执行的两步谵妄识别协议的可行性，管理时间，有效性和成本，以及由认证护理助理（CNA）执行的超简短筛选器，他们将通知护士异常结果。目的3）对上述入组的400例患者的谵妄识别过程进行定性研究，包括直接观察和在每个方案结束时对参与者进行简短的开放式访谈，以确定方案实施的障碍和促进因素。影响：目前的目标将利用我们以前的工作，并将为我们提供必要的工具和知识，以实施实用，有效和具有成本效益的协议，用于检测和监测住院老年患者的谵妄。因此，我们的工作将推动谵妄研究领域的发展，并具有提高护理质量、降低成本和促进弱势老年人独立的巨大潜力。

 DESCRIPTION (provided by applicant): Delirium affects up to 50% of hospitalized older adults, and is independently associated with functional and cognitive decline, nursing home placement, mortality, and $164 billion in U.S. healthcare costs. Despite these compelling figures, under-recognition of delirium remains a major problem. In this setting, there is increasing interest in implementing systematic delirium identification in U.S. hospitals, yet, ther is very little evidence on how to implement such programs in an effective and efficient manner. Our goals are to develop a practical, effective, and cost-efficient protocol for detection and monitoring of delirium in high risk hospitalized older adults, and to generate the evidence base needed to facilitate its widespread implementation. The products of our first cycle of funding from R01AG030618, "3D-CAM: Deriving and Validating a 3-minute Diagnostic Assessment for Delirium", will serve as key components of our protocol. These include: 1) the 3D-CAM; a highly performing diagnostic interview for delirium that can be completed in 3 minutes; 2) an ultra-brief (30-40 second) 2-item screener that can effectively rule out delirium. We now propose to 1) validate the screener in 2 independent cohorts; 2) combine the screener and 3D-CAM into a 2-step delirium identification protocol; 3) measure the effectiveness and cost-efficiency of having clinicians administer this protocol; 4) employ qualitative methods to determine barriers and facilitators to implementing the protocol. Thus, our application, "READI: Researching Efficient Approaches to Delirium Identification", has the following Specific Aims: Aim 1) To independently validate our 2-item ultra-brief screener in two large, existing cohorts of older patients with rigorously performed delirium assessments: 1) SAGES: Successful Aging after Elective Surgery, a post- surgical sample free of baseline dementia (N=566), and 2) END-DSD: Early Nurse Detection of Delirium Superimposed on Dementia (N=391), an acute hospital sample, all of whom have dementia. Aim 2) In a new cohort of 400 general medicine patients recruited from a large urban academic medical center and a small rural community hospital, to assess the feasibility, administration time, effectiveness, and costs of the 2-step delirium identification protocol performed by physicians and nurses, and the ultra-brief screener performed by certified nursing assistants (CNA's), who will notify the nurse of an abnormal result. Aim 3) To conduct a qualitative study of the delirium identification process in the 400 patients enrolled above, including both direct observation and brief open-ended interviews with participants at the end of each protocol to determine barriers and facilitators to implementation of the protocol. Impact: The current Aims will leverage our previous work, and will give us the necessary tools and knowledge to implement a practical, effective, and cost-efficient protocol for detection and monitoring of delirium in hospitalized older patients. Therefore, our work will move the field of delirium research forward, and has great potential to improve quality of care, reduce costs, and promote the independence of vulnerable older adults.