Developing a PREPARE for Your Care delivery system to enhance adoption by healthcare organizations

项目摘要 背景：人口正在老龄化，慢性病正在增加，数百万老年人缺乏对疾病的准备。 复杂的医疗决策，导致不知情的决定和护理与个人目标不一致。的目标 先进的护理计划（ACP）是为了确保患者接受符合他们的目标和偏好的医疗护理。我们 该团队创建了基于证据的交互式在线PREPAREforYourCare.org）ACP计划， 帮助讲英语和西班牙语的人发展技能，以澄清他们的价值观，沟通他们的愿望， 做出明智的医疗决定。在试验中，ESTA帮助98%的英语和西班牙语的老年人参与 在ACP中，医疗记录中ACP决定的记录增加到43%。自2013年以来， 超过350，000个独立用户，材料已被翻译成多种语言;然而， 由于繁重的许可和采购复杂性，医疗保健系统仍然很低， 可能不符合组织需求的材料，以及缺乏如何将材料整合到临床中的指导 工作流程。本提案的目标是开发、完善和评估以采用者为中心的CECE交付 系统（PDS），以简化在医疗保健组织内选择、许可和实施医疗保健电子设备的过程。 其目标是提高CCAE的采用率和盈利能力，并使团队能够申请第二阶段SBIR 资金用于测试在不同类型的医疗保健和相关组织中的采用和实施。目标1：我们将 确定哪些可扩展资产（即，网站，预先指示，小册子，视频），是医疗保健所需要的 组织以及组织希望如何访问和许可资产。目标2：我们将建立一个PDS原型， 包括所需的资产，并解决利益相关者在许可和实施方面的障碍。目标3：我们将确定 通过在利益相关者潜在采用者中进行试点测试，确定PDS的可行性。方法：我们将深入开展 与来自广泛的潜在采用组织（包括基于社区的组织）的医疗保健利益相关者进行访谈 医院，县医院，三级学术医疗中心，和卫生保健为基础的社区组织，并分析 使用定性内容分析的数据（目标1和2）。我们还将评估PDS的可行性和满意度 使用经过验证的调查和深入访谈（目标3）。我们假设利益相关者将确定首选的 资产和采用障碍，继续提供关于PDS需要改进的反馈， 开发过程，并报告PDS是可行的，并报告对交付系统的高满意度。 与NIH和公共卫生的相关性：广泛采用和实施基于证据的CTEE 该计划可能会减少文化和语言多样化的老年人之间ACP的健康差异。预计 成果包括一个功能PDS原型和初步数据，以申请第二阶段资金，我们将进一步 开发和部署公共卫生系统，并衡量医疗保健系统内采用和传播公共卫生教育计划的情况 系统.

PROJECT SUMMARY Background: The population is aging, chronic illness is increasing, and millions of older adults lack preparation for complex medical decision making, leading to uninformed decisions and care inconsistent with personal goals. The goal of advance care planning (ACP) is to ensure that patients receive medical care aligned with their goals and preferences. Our team has created the evidenced-based, interactive online PREPAREforYourCare.org (PREPARE) ACP program that helps English and Spanish-speaking individuals develop the skills to clarify their values, communicate their wishes, and make informed medical decisions. In trials, PREPARE helped 98% of English and Spanish-speaking older adults engage in ACP and increased documentation of ACP decisions in the medical record up to 43%. Since 2013, PREPARE has had over 350,000 unique users and the materials have been translated into multiple languages; yet reach and adoption by healthcare systems remains low due to burdensome licensing and purchasing complexity, packaging of PREPARE materials that may not meet organizations’ needs, and lack of guidance for how to integrate the materials into clinical workflows. The objective of this proposal is to develop, refine, and evaluate an adopter-focused PREPARE Delivery System (PDS) to ease the process of selecting, licensing, and implementing PREPARE within healthcare organizations. The goal is to improve adoption and profitability of PREPARE and to position the team to apply for Phase II SBIR funding to test adoption and implementation among varying types of healthcare and related organizations. Aim 1: We will determine what PREPARE assets (i.e., website, advance directives, pamphlets, videos), are wanted by healthcare organizations and how organizations want to access and license the assets. Aim 2: We will build a PDS prototype that includes the desired assets and addresses stakeholder barriers to licensing and implementation. Aim 3: We will determine the feasibility of the PDS by pilot testing among stakeholder potential adopters. Methods: We will conduct in-depth interviews with healthcare stakeholders from a wide range of potential adopting organzations including community-based hospitals, county hospitals, tertiary academic medical centers, and healthcare-based community organizations and analyze the data using qualitative content analysis (Aims 1 and 2). We will also assess feasibility and satisfaction with the PDS using validated surveys and in-depth interviews (Aim 3). We hypothesize that stakeholders will identify preferred PREPARE assets and barriers to adoption, continue to provide feedback on needed refinements of the PDS over the course of development, and report that the PDS is feasible and report high satisfaction with the deliveray system. Relevance to NIH and public health: Widespread adoption and implementation of the evidenced-based PREPARE program may reduce health disparities in ACP among culturally and linguistically diverse older adults. Expected Outcomes include a functional PDS prototype and preliminary data to apply for Phase II funding in which we will further develop and deploy the PDS and measure adoption and dissemination of the PREPARE program within healthcare systems.