ED GOAL: An Advance Care Planning Intervention for Seriously Ill Older Adults in the Emergency Department

K76行政补充申请 项目总结/摘要 这是Kei Ouchi，MD的母公司奖励（K76 AG 064434）的行政补充， MPH，MS，这将确保在他的家庭医疗紧急情况下持续的生产力 并且不会改变父母奖励的范围。大内博士致力于引领 急诊医学结合老年医学和姑息医学的原则。大内医生是 急诊医生和家庭医院医生（在患者的 家1）在布里格姆妇女医院/哈佛急诊科 医学院大内博士的研究重点是开发艾德目标，一个6分钟的 在急诊科（艾德）进行的动机访谈，使患者参与 解决与门诊临床医生的高级护理计划（ACP）对话， 在时间紧迫的艾德环境中进行耗时、敏感的谈话。的资助下 NIA GEMSSTAR R 03和急诊医学基金会，大内博士开发了艾德目标 并证明了其在ED中重病老年人中的可接受性和可行性。艾德目标 也可能增加患者离开后自我报告的ACP参与和ACP记录 GEMSSTAR项目确定，在资源有限的情况下，艾德 GOAL需要改进，以最大限度地发挥其潜在功效。本研究将完善艾德目标， 最大限度地发挥其潜在的功效和可扩展性，并确定改进的初步功效 艾德的目标是在离开教育署一个月后增加机场核心计划的参与。 培养计划加速了大内博士作为一名独立的医学科学家的职业发展 通过以下方面的培训：1）认知障碍评估和ACP护理人员的参与 研究（艾德GOALCG）; 2）由经过专门培训的护士改编艾德GOAL/艾德GOALCG; 3） 由受过专门培训的护士进行艾德GOAL/艾德GOALCG的临床试验;以及 4)实施科学为艾德GOAL/艾德未来实用临床试验做准备 GOALCG。James Tulsky，医学博士，国际公认的姑息医学领导者，将担任 作为主要的导师大内博士是共同指导：1）玛拉Schonberg，医学博士，公共卫生硕士，领导者在 老年人的健康服务研究; 2）Edward Boyer，医学博士，博士，K24资助的 急诊医学研究员，在行为干预方面有专长。最终目标是 将艾德目标作为国家护理标准，以帮助所有患有重病的老年人接受 在他们生命中最关键的时刻进行ACP对话。大内博士旨在扩大 从急性、疾病导向的护理（例如，枪伤），包括患者- 集中护理（例如，以价值为基础的临终关怀）， 老年医学和姑息医学原则。

K76 Administrative Supplement Application Project Summary/Abstract This is an administrative supplement to the parent award (K76AG064434) of Kei Ouchi, MD, MPH, MS, which will ensure continued productivity during his family medical emergency and will not change the scope of the parent award. Dr. Ouchi is committed to lead the field of emergency medicine to integrate the principles of geriatrics and palliative medicine. Dr. Ouchi is an emergency physician and home hospital physician (provides inpatient-level care at patient's home1) in the Department of Emergency Medicine, Brigham and Women's Hospital/Harvard Medical School. Dr. Ouchi's research focuses on the development of ED GOAL, a 6-minute motivational interview conducted in the emergency department (ED), which engages patients to address advance care planning (ACP) conversations with their outpatient clinicians and avoids a time-consuming, sensitive conversation in the time-pressured ED environment. With funding from the NIA GEMSSTAR R03 and Emergency Medicine Foundation, Dr. Ouchi developed ED GOAL and demonstrated its acceptability and feasibility in seriously ill older adults in the ED. ED GOAL may also increase patients' self-reported ACP engagement and ACP documentation after leaving the ED. The GEMSSTAR project identified that, in this setting where resources are limited, ED GOAL requires refinements to maximize its potential efficacy. This study will refine ED GOAL to maximize its potential efficacy and scalability, and determine the preliminary efficacy of the refined ED GOAL to increase ACP engagement one month after leaving the ED. The proposed 5-year training plan accelerates Dr. Ouchi's career development as an independent physician-scientist through training in: 1) cognitive impairment assessment and engagement of caregivers in ACP research (ED GOALCG); 2) adaptation of ED GOAL/ ED GOALCG by specially-trained nurses; 3) conducting a clinical trial of ED GOAL/ ED GOALCG administered by specially-trained nurses; and 4) implementation science in preparation for a future pragmatic clinical trial of ED GOAL/ ED GOALCG. James Tulsky, MD, an internationally recognized leader in palliative medicine, will serve as the primary mentor. Dr. Ouchi is co-mentored by: 1) Mara Schonberg, MD, MPH, a leader in health services research among older adults; and 2) Edward Boyer, MD, PhD, a K24-funded emergency medicine researcher with expertise in behavioral interventions. The ultimate goal is to establish ED GOAL as a national standard of care to help all seriously ill older adults to receive ACP conversations at the most critical times of their lives. Dr. Ouchi aims to expand the scope of ED-based care from acute, disease-oriented care (e.g., gunshot wounds) to include patient- centered care (e.g., value-based, end-of-life care) for seriously ill older adults by integrating geriatrics and palliative medicine principles.