Improving Palliative Care Access through Technology (ImPAcTT): A Multi-Component Pilot Study

项目摘要 这辆K76保罗B。比森新兴领导人职业发展奖在老龄化建议提供博士。 卡罗琳斯蒂芬斯，新晋升的副教授在加州大学旧金山分校护理学院，与导师 转化定性研究、实施科学、临床试验和领导力方面的培训 发展拟议的培训和支持将为她提供必要的额外技能， 一个变革性的跨学科领导人在老龄化和姑息治疗研究谁审查和促进 在医疗保健系统的交界处进行改革，以改善姑息治疗服务的可及性，并为难以接受的人提供支持。 护理之家（Nursing Home）她组建了一支优秀的多学科导师团队， 具有以下专业领域的科学顾问：临床老年医学和姑息治疗（克莉丝汀博士 里奇和Sei Lee）;实施科学（C.里奇和S.综合护理提供模式， 体弱的老人（C。里奇和L.测量和改善卫生保健质量（S。李， Charlene哈灵顿，Joseph Ouslander）;开发/评估以患者为中心的技术，如远程医疗， 改善医疗复杂的老年人的护理（博士C。里奇和L. Branagan）;统计专业知识 临床试验设计和复杂数据集的分析（J. Neuhaus博士）;长期护理健康政策（C. 哈灵顿）;转化的定性研究方法（博士J.沈）;开发，测试和评估多 在NH环境中的成分干预（J. Ouslander博士）。 沟通欠佳，无法及时获得适当的姑息治疗专业知识和支持 在NH环境中，通常会导致繁重的过渡，特别是在生命结束时。斯蒂芬斯博士的研究 将侧重于开发、优化和试点测试一个多组件的"通过 利用现有远程保健技术提供工作人员教育的技术干预措施; 家庭外展，参与和支持;护理协调;和居民症状管理， 促进护理目标的讨论。ImPAcTT采用安全的通信平台，允许多个 实时视频、音频和短信咨询;实时文档共享和文档记录， 高级护理计划讨论;以及远程虚拟评估功能。在目标1中，她将进行 与NH工作人员，居民和家庭进行半结构化访谈，以探索潜在的障碍和促进因素， 使用远程医疗来增加上游对PC专业知识、支持和教育的访问。在目标2中，她将 评估远程医疗提供NH姑息治疗教育和支持的技术可行性，并开发 并与多达10名NH居民、家庭和工作人员一起完善研究方案。在目标3中，她将引导一个飞行员 在3家医院进行实施试验，以评估多组分ImPAcTT的可行性和可接受性 干预这些研究将为R 01应用提供科学基础， 多中心RCT中ImPAcTT干预的结局。

PROJECT SUMMARY ABSTRACT This K76 Paul B. Beeson Emerging Leaders Career Development Award in Aging proposes to provide Dr. Caroline Stephens, a newly promoted Associate Professor in the UCSF School of Nursing, with mentorship and training in translational qualitative research, implementation science, clinical trials, and leadership development. The proposed training and support will provide her with the necessary additional skills to become a transformative interdisciplinary leader in aging and palliative care research who examines and promotes changes at the junctures of healthcare systems to improve access to palliative care services and supports for hard to reach nursing home (NH) populations. She has assembled an excellent multidisciplinary team of mentors and scientific advisors with the following areas of expertise: clinical geriatrics and palliative care (Drs. Christine Ritchie and Sei Lee); implementation science (Drs. C. Ritchie and S. Lee); integrated care delivery models for frail elders (Dr. C. Ritchie and L. Branagan); measuring and improving health care quality in NHs (Drs. S. Lee, Charlene Harrington, Joseph Ouslander); developing/evaluating patient-centered technologies, such as telehealth, for improving care for medically complex older adults (Drs. C. Ritchie and L. Branagan); statistical expertise on clinical trial design and analysis of complex datasets (Dr. J. Neuhaus); long term care health policy (Dr. C. Harrington); translational qualitative research methods (Dr. J. Shim); developing, testing and evaluating multi- component interventions in the NH setting (Dr. J. Ouslander). Suboptimal communication and lack of access to appropriate and timely palliative care expertise and support in the NH setting often leads to burdensome transitions, particularly at the end of life. Dr. Stephens' research will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion. ImPAcTT employs a secure communications platform that permits multi- person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities. In Aim 1, she will conduct semi-structured interviews with NH staff, residents and families to explore potential barriers and facilitators to using telehealth for increasing upstream access to PC expertise, support, and education. In Aim 2, she will assess the technical feasibility of telehealth to provide NH palliative care education and support, and develop and refine study protocols with up to 10 NH residents, families and staff. In Aim 3, she will conduct a pilot implementation trial in 3 NHs to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention. These studies will provide the scientific foundation for a compelling R01 application to evaluate the outcomes of this ImPAcTT intervention in a multi-site RCT.