ED GOAL: An Advance Care Planning Intervention for Seriously Ill Older Adults in the Emergency Department

项目总结 这是保罗·B·比森新兴领导者职业生涯的重新提交，由医学博士、公共卫生硕士、硕士研究生Kei Ouchi撰写 老龄发展奖(K76)。Ouchi博士致力于引领急诊医学领域整合 老年病学和姑息医学的原理。Ouchi医生是一名急诊医生，也是家庭医院 布里格姆急诊科医生(在患者家中提供住院级护理10) 和妇女医院/哈佛医学院。Ouchi博士的研究重点是ED Goal的发展， 在急诊科(ED)进行的6分钟激励性访谈，让患者参与到 解决与其门诊临床医生的高级护理计划(ACP)对话，并避免 在时间紧迫的ED环境中进行耗时、敏感的对话。在NIA的资助下 GEMSSTAR R03和急诊医学基金会，Ouchi博士开发了ED Goal并展示了其 急诊科重病老年人的可接受性和可行性。ED目标也可能增加患者的自我意识 离开ED后，报告了ACP参与和ACP文档。GEMSSTAR项目确定了 在这种资源有限的情况下，ED Goal需要改进，以最大限度地发挥其潜在效力。 本研究将细化ED的目标，以最大限度地发挥其潜在的疗效和可扩展性，并初步确定 改进的ED目标的有效性，即在离开ED一个月后增加ACP参与度。建议数 五年培训计划通过以下方式加速Ouchi博士作为独立内科科学家的职业发展 培训内容：1)认知障碍评估和照顾者参与ACP研究(Ed GOALCG)； 2)经过专门培训的护士对ED Goal/ED GOALCG进行适配；3)进行ED Goal/的临床试验 由受过专门训练的护士管理的Ed GOALCG；以及4)为未来做准备的实施科学 ED Goal/ED GOALCG的实用临床试验。詹姆斯·图尔斯基医学博士，国际公认的研究人员 而姑息医学领域的领导者将担任主要导师。Ouchi博士的共同导师是：玛拉 Schonberg，医学博士，公共卫生硕士，老年人健康服务研究的领导者；2)Edward Boyer，医学博士，博士， K24资助的急救医学研究人员，具有行为干预方面的专业知识。这件事的高潮 职业发展奖将确保Ouchi博士获得他所拥有的高级研究技能和知识 需要对ED Goal进行大规模、务实的试验。最终目标是将ED目标确立为 国家护理标准，帮助所有重病老年人最多接受ACP对话 他们生命中的关键时刻。Ouchi博士的目标是将急诊护理的范围从急性、疾病- 以病人为中心的护理(如枪伤)(如基于价值的临终护理) 通过整合老年病学和姑息医学原理，为重病老年人提供帮助。

PROJECT SUMMARY This is a resubmission by Kei Ouchi, MD, MPH, MS for the Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76). Dr. Ouchi is committed to lead the field of emergency medicine to integrate the principles of geriatrics and palliative medicine. Dr. Ouchi is an emergency physician and home hospital physician (provides inpatient-level care at patient’s home10) in the Department of Emergency Medicine, Brigham and Women’s Hospital/Harvard Medical School. Dr. Ouchi’s research focuses on the development of ED GOAL, a 6-minute motivational interview conducted in the emergency department (ED), which engages patients to address advance care planning (ACP) conversations with their outpatient clinicians and avoids a time- consuming, sensitive conversation in the time-pressured ED environment. With funding from the NIA GEMSSTAR R03 and Emergency Medicine Foundation, Dr. Ouchi developed ED GOAL and demonstrated its acceptability and feasibility in seriously ill older adults in the ED. ED GOAL may also increase patients’ self- reported ACP engagement and ACP documentation after leaving the ED. The GEMSSTAR project identified that, in this setting where resources are limited, ED GOAL requires refinements to maximize its potential efficacy. This study will refine ED GOAL to maximize its potential efficacy and scalability, and determine the preliminary efficacy of the refined ED GOAL to increase ACP engagement one month after leaving the ED. The proposed 5-year training plan accelerates Dr. Ouchi’s career development as an independent physician-scientist through training in: 1) cognitive impairment assessment and engagement of caregivers in ACP research (ED GOALCG); 2) adaptation of ED GOAL/ ED GOALCG by specially-trained nurses; 3) conducting a clinical trial of ED GOAL/ ED GOALCG administered by specially-trained nurses; and 4) implementation science in preparation for a future pragmatic clinical trial of ED GOAL/ ED GOALCG. James Tulsky, MD, an internationally recognized researcher and leader in palliative medicine will serve as the primary mentor. Dr. Ouchi is co-mentored by: 1) Mara Schonberg, MD, MPH, a leader in health services research among older adults; and 2) Edward Boyer, MD, PhD, a K24-funded emergency medicine researcher with expertise in behavioral interventions. The culmination of this career development award will ensure that Dr. Ouchi gains the advanced research skills and knowledge that he needs to conduct a large, pragmatic trial of ED GOAL. The ultimate goal is to establish ED GOAL as a national standard of care to help all seriously ill older adults to receive ACP conversations at the most critical times of their lives. Dr. Ouchi aims to expand the scope of ED-based care from acute, disease- oriented care (e.g., gunshot wounds) to include patient-centered care (e.g., value-based, end-of-life care) for seriously ill older adults by integrating geriatrics and palliative medicine principles.