ED-LEAD: Emergency Departments LEading the transformation of Alzheimer's and Dementia care

项目总结 对于痴呆症患者(PLWD)来说，急诊科(ED)就诊是一项关键事件， 有机会解决访问前未得到满足的需求。我们的多重PI(MPI)团队一起 在50家急诊室以及多家临终关怀和家庭健康中心进行了整群随机、多点试验 机构，并独一无二地准备解决以前在开发可伸缩模型方面的缺陷 照顾PLWD。通过这项工作以及我们的合作调查员的工作，我们开发并测试了三个 与前往急诊室就诊的PLWD及其护理伙伴相关的干预措施：1)紧急护理重新设计 (UH3AT009844)通过数字警报和 站点之间的结构化协作，已显示可增加对先行护理计划的识别，并 争取多学科支持；2)护士主导的电话护理计划(PCORI)，增加了进步 护理计划和将患者与临终关怀中心联系起来；以及3)社区辅助医务人员领导的结构化指导 干预(R01AG050504)将30天内ED再次就诊的几率降低75%。以此为基础 证据表明，EDS领导阿尔茨海默氏症和痴呆症护理(ED- 领导)是将急诊室的访问从危机转变为改善可持续发展妇女的福祉和他们的护理的机会 合伙人。ED-Lead将嵌入一个由14个卫生系统组成的不同小组，其中包括80个具有 种族和民族的多样性，以教育为单位的随机化。行政核心意志 监督所有管理里程碑的完成，包括整合两个NIA的专业知识和指导- 有资金支持的网络和外部咨询委员会。实施核心将：1)协调核心职能 和流程；2)优化临床决策支持；3)实现三者之间的干预保真度 干预措施。最后，一个统计分析核心将提供生物统计和数据管理支助。我们的 具体目标是：1)优化同时运行的急救护理重新设计、护士领导的电话护理，以及 社区辅助医务人员主导的PLWD过渡干预，以实现两个急救中心的可行性、保真度和可用性；2) 研究这三种干预措施单独和联合治疗患有严重疾病的PLWD的有效性 一项嵌入80个ED的整群随机多因素试验：ED复诊、住院和健康 索引ED访问后在家的天数；以及3)确定站点、提供者、患者和护理合作伙伴级别 不同人群中的特征与实施每项干预措施的不同有关。艾德- Lead将解决美国国家科学院、工程院和医学院注意到的缺陷 通过提供可能改善生活和减少痛苦的高质量、真实世界的证据来报告PLWD 和他们的护理伙伴。它将解决NIA和国家阿尔茨海默氏症计划的关键战略目标 “实施和评估新的护理模式，以支持有效的护理过渡”，并提供卫生系统 有必要的证据来扩大对这一弱势群体的干预。

PROJECT SUMMARY In persons living with dementia (PLWD), an Emergency Department (ED) visit is a critical event and an opportunity to address the unmet needs that preceded the visit. Our multiple PI (mPI) team have together conducted cluster-randomized, multi-site trials in >50 EDs as well as multiple hospice and home health agencies, and are uniquely poised to address previous shortcomings in the development of scalable models of care for PLWD. Through this work, and that of our co-investigators, we have developed and tested three interventions relevant to PLWD and their care partners who visit the ED: 1) emergency care redesign (UH3AT009844) of new and intentional workflows for emergency providers reinforced by digital alerts and structured collaboration between sites, already shown to increase identification of advance care plans and enlisted multidisciplinary support; 2) a nurse-led telephonic care program (PCORI) that increased advance care planning and connected patients to hospice; and 3) a community paramedic-led structured coaching intervention (R01AG050504) that reduced the odds of an ED revisit within 30 days by 75%. Building on this evidence, the overarching goal of EDs LEading the Transformation of Alzheimer’s and Dementia Care (ED- LEAD) is to turn an ED visit from a crisis into an opportunity to improve the well-being of PLWD and their care partners. ED-LEAD will be embedded in a diverse group of 14 health systems, including 80 EDs with substantial racial and ethnic diversity, with the ED as the unit of randomization. An Administrative Core will oversee completion of all administrative milestones including integrating expertise and guidance from two NIA- funded networks and an External Advisory Board. An Implementation Core will: 1) harmonize core functions and processes; 2) optimize clinical decision support; and 3) and enable intervention fidelity across the three interventions. Finally, a Statistical Analysis Core will provide biostatistical and data management support. Our specific aims are to: 1) optimize a concurrently run emergency care redesign, nurse-led telephonic care, and community paramedic-led transitions intervention in PLWD for feasibility, fidelity and usability in two EDs; 2) study the effectiveness of these three interventions, alone and in combination, for PLWD with serious illness in a cluster-randomized multifactorial trial embedded within 80 EDs on: ED revisits, hospitalizations, and healthy days at home following the index ED visit; and 3) determine site, provider, patient, and care partner-level characteristics within a diverse population associated with variation in implementation of each intervention. ED- LEAD will address shortcomings noted in the National Academies of Sciences, Engineering, and Medicine report on PLWD by providing high-quality, real-world evidence that may improve the lives and reduce suffering of PLWD and their care partners. It will address key strategic goals of NIA and the National Alzheimer’s Plan to “implement and evaluate new care models to support effective care transitions”, and provide health systems with the necessary evidence to scale interventions for this vulnerable population.