Community Paramedicine

项目摘要 大约有300万已知的痴呆症（PLWD）患者前往急诊室（艾德）就诊 每年。这可能是一个被低估的价值，因为大多数痴呆症病例在ED中未被识别。 艾滋病患者得到治疗和释放，这意味着他们不需要医疗监督， 复苏然而，对于PLWD，从ED到家庭的过渡与艾德复诊的风险增加有关，不良反应发生率增加。 事件和死亡率。已确定迫切需要对艾滋病患者进行有效的护理过渡干预 由NIA资助的老年紧急护理应用研究2.0网络-推进痴呆症护理。我们 适应科尔曼的护理过渡干预，由社区护理人员为社区提供- 居住老年人从ED过渡到家庭，30天内艾德复诊的几率降低了75% 在认知障碍患者中。这些结果为检验该社区奠定了基础 在一项大规模嵌入式实用临床试验中， 评估其在改善PLWD从急诊到家庭过渡方面的有效性。在这项研究中，我们将测试我们的 假设CPTI将改善PLWD从ED到家庭的过渡和利用结果， 无论是单独还是与其他干预措施相结合。我们将利用社区护理人员， 创新和新的医疗保健模式，其中护理人员在其传统角色之外发挥作用， 社区卫生干预。我们将与护士领导的 PLWD的电话护理和艾德护理重新设计，评估干预的可接受性和参与度。我们 将在一个80个中心的集群中单独测试CPTI的有效性，并与其他干预措施相结合， 社区居住PLWD及其护理的随机、多因素嵌入式实用临床试验 通过分析艾德再访率、住院率和在家总天数，确定经历艾德访视的伴侣 指数艾德访视后。我们还将确定研究中心、提供者和患者级别的特征， 使用RE-AIM框架与CPTI结果变化相关，以便未来的实施可以 充分解决这些护理差距。这项研究完成后，将填补以下重要空白： 接受艾德护理的PLWD被忽视的从急诊到家庭的过渡。通过严格调查CPTI，我们将 提供关键证据，说明如何改善PLWD的健康结果，并实现未充分利用的医疗保健 为这些弱势群体提供资源。

PROJECT SUMMARY Approximately 3 million known persons living with dementia (PLWD) visit the emergency department (ED) annually. This is likely an underestimated value as most cases of dementia go unrecognized in the ED. Most PLWD are treated and released, implying that they do not need medical oversight and are on the road to recovery. Yet, for PLWD, the ED-to-home transition is associated with increased risk of ED revisits, adverse events, and mortality. The critical need for effective care transition interventions for PLWD has been identified by the NIA-funded Geriatric Emergency Care Applied Research 2.0 Network – Advancing Dementia Care. Our adaptation of the Coleman’s Care Transitions Intervention, delivered by community paramedics for community- dwelling older adults transitioning from ED-to-home, reduced the odds of ED revisits within 30 days by 75% among patients with cognitive impairment. These results lay the foundation for testing the Community Paramedic-Led Transitions Intervention (CPTI) in a large-scale embedded pragmatic clinical trial to rigorously evaluate its effectiveness in improving the ED-to-home transitions for PLWD. In this study, we will test our hypothesis that the CPTI will improve the ED-to-home transition and utilization outcomes for PLWD, both alone and when combined with other interventions. We will leverage community paramedicine, an innovative and new health care model where paramedics function outside their traditional roles to deliver community health interventions. We will optimize the CPTI across two sites in coordination with the Nurse-led Telephonic Care and ED Care Redesign for PLWD, assessing intervention acceptability and engagement. We will test the CPTI’s effectiveness alone and in combination with the other interventions in an 80-center, cluster- randomized, multifactorial embedded pragmatic clinical trial for community-dwelling PLWD and their care partners experiencing an ED visit by analyzing ED revisit rates, hospitalizations, and total days at home following an index ED visit. We will also determine site, provider, and patient-level characteristics that are associated with CPTI outcome variations using the RE-AIM framework, such that future implementation can adequately address these care gaps. Upon its completion, this study will address the important gap of overlooked ED-to-home transitions for PLWD receiving ED care. By rigorously investigating the CPTI, we will provide critical evidence on ways to improve PLWD health outcomes and enable underutilized healthcare resources for this vulnerable population.