Emergency General Surgery Delirium Recovery Model: A Collaborative Care Intervention

项目摘要 妄想症是一种复杂的神经精神综合征，其特征是认知的剧烈和波动变化。 和意识。精神错乱的幸存者患有认知、身体和心理上的一系列疾病 残疾人士。这些残疾导致医疗保健利用率高、生活质量降低和功能丧失 独立。更糟糕的是，一次精神错乱会增加阿尔茨海默病和相关疾病的风险 痴呆症。根据我们小组的工作和其他人的工作，超过25%的患者接受了 急诊腹内手术期间至少出现一次精神错乱。 住院，使他们处于认知衰退的高风险中。在知识上有一个根本性的鸿沟 关于预防患者认知、心理和功能衰退的最佳方法 急诊普通外科手术，随后发展为精神错乱。这一系列研究的长期目标是 改善老年急诊普外科手术幸存者的健康和护理质量。这样做的目的是 应用是将协作护理的概念应用于高危患者群体。印第安纳大学 威斯康星大学医学院和公共卫生学院的研究人员已经超过 20年来开发创新、高效的协作护理模式的经验，这些模式与 初级保健和专科医生，以满足慢性阻塞性肺疾病患者复杂的生物心理社会需求 疾病状态，如痴呆症和抑郁症。我们的团队开发了一种特定的协作护理模式 名为急诊普通外科妄想症恢复计划。这项提案旨在进行一项 随机对照试验评估12个月协作护理在改善患者生活质量方面的效果 急诊腹部手术患者的认知、功能和心理康复 术后至少有一次精神错乱，且年龄在65岁以上。审判已经进行了 以下具体目标：1)评估急诊普通外科妄想症康复模式的能力 改善老年急诊普外科精神障碍幸存者的认知恢复；以及2)评估 急诊普外科妄想症康复模式对提高老年人身体恢复能力的研究 急诊普外科精神障碍幸存者；3)评估急诊普外科的能力 提高老年急诊普外科妄想症患者心理康复的康复模式 幸存者。本申请中提出的研究具有创新性，因为它代表了一种新的和实质性的 背离现状。以前的协作护理模式侧重于慢性护理管理和 它们缺乏快速的适应性。我们还调整了干预措施，使之完全通过远程保健完成。这 随着急诊普通外科惊恐恢复的广泛应用，将做出重大贡献 在全国各地的医院实施这一计划可能会改善健康状况，提高护理质量 尤其是脆弱的患者群体。

Project Summary Delirium is a complex neuropsychiatric syndrome characterized by acute and fluctuating changes in cognition and consciousness. Delirium survivors suffer from a cluster of cognitive, physical, and psychological disabilities. These disabilities lead to high healthcare utilization, lower quality of life, and loss of functional independence. Worse, a single episode of delirium increases the risk of Alzheimer disease and related dementias. Based on work from our group and the work of others, over 25% of patients who undergo emergency intra-abdominal surgery suffer from at least one episode of delirium during the index hospitalization, putting them at high risk for cognitive decline. There is a fundamental gap in knowledge regarding the best way to prevent cognitive, psychological and functional decline in patients who undergo emergency general surgery and subsequently develop delirium. The long-term goal of this line of research is to improve the health and quality of care for older emergency general surgery survivors. The objective of this application is to apply the concepts of collaborative care to a high-risk patient population. Indiana University School of Medicine and University of Wisconsin School of Medicine and Public Health researchers have over 20 years of experience developing innovative and effective collaborative care models that integrate with primary care and specialty physicians to address the complex biopsychosocial needs of patients with chronic disease states, such as dementia and depression. Our team has developed a specific collaborative care model called the Emergency General Surgery Delirium Recovery Program. This proposal aims to conduct a randomized controlled trial to evaluate the efficacy of 12-months of collaborative care in improving the cognitive, functional and psychological recovery of emergency intra-abdominal surgery patients who suffer at least one episode of delirium in the post-operative period and are at least 65 years old. The trial has the following specific aims: 1) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the cognitive recovery of older Emergency General Surgery delirium survivors; and 2) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the physical recovery of older Emergency General Surgery delirium survivors; and 3) Evaluate the ability of the Emergency General Surgery Delirium Recovery Model to improve the psychological recovery of older Emergency General Surgery delirium survivors. The research proposed in this application is innovative because it represents a new and substantive departure from the status quo. Previous collaborative care models focused on chronic care management and they lack rapid adaptability. We have also adapted the intervention to be completed solely via telehealth. This contribution will be significant as broad application of the Emergency General Surgery Delirium Recovery Program at hospitals across the country could result in better health and improved quality of care for a particularly vulnerable patient population.