Nursing Home Prevention of Injury in Dementia (NH PRIDE)

摘要： 受伤的福尔斯是常见的，病态的，和昂贵的养老院（NH）的居民，特别是那些与 阿尔茨海默病及相关痴呆症（ADRD）。我们的长期目标是减少NH的伤害性福尔斯 居民目前的提案将制定一项伤害联络服务（ILS）干预措施，旨在促进 取消精神活性和心脏代谢药物的处方，并鼓励骨质疏松症的治疗。的 干预措施将解决NH研究中遇到的常见跌倒预防障碍， 通信提出了以下具体目标：1）制定一个旨在预防ILS的护理模式， 伤害性福尔斯在NH居民使用a）自动风险计算器，以确定高风险居民，B）集中 由伤害联络护士进行护理协调，以及c）与NH工作人员进行视频会议; 2）测试ILS的 在有和没有ADRD的居民中的四个NH设施中的实施效果;以及3）制定 在2-3个NH链中ILS模型的2期有效性试验的方案和资源。核心假设是 ILS模式将通过减少处方和增加医疗服务来减少伤害性福尔斯跌倒。 骨质疏松症的治疗我们假设，实施障碍是更大的居民与ADRD， 它需要反复干预修改才能在该人群中实现依从性。我们将使用 目标1中基于经验的共同设计原则，召集关键利益相关者， 将干预措施转化为一个单一的、务实的护理模式，可以在整个卫生系统中传播。在目标2中， 我们将在四个NH设施中实施护理模式。这将需要对预测模型进行编程 在EMR中识别高风险居民。一个集中的ILS护士将制定取消处方 建议和骨质疏松症治疗的高风险居民（n~80）从偏远地区。 将利用电视会议促进教育和交流。我们将衡量执行情况 成功使用后干预措施的可接受性，需求，保真度和实用性。有效性将 使用过程测量（例如，药物剂量减少），以及安全性 将使用最小数据集（MDS）的前后测量和图表审查进行评估，分层 按ADRD状态。此外，我们将验证未来务实试验的计划主要结局， 通过病历审查，从MDS中确定福尔斯。在目标3中，我们将制定协议和所有材料 在2-3个NH链内进行ILS的嵌入式实用临床试验所需的。研究团队 具有相当丰富的NH研究经验，包括实施科学。完成后 研究，我们将开发一个强大的护理模式，可以随时部署的NH系统和评估 因为它对ADRD居民的伤害性福尔斯的影响。我们将在理想的位置进行务实的临床 试验嵌入NH系统，以测试ILS的有效性。除了解决伤害性福尔斯， 模型有可能被修改为其他复杂的老年综合征在NH居民ADRD。

Abstract: Injurious falls are common, morbid, and costly for nursing home (NH) residents, particularly those with Alzheimer’s Disease and Related Dementias (ADRD). Our long-term goal is to reduce injurious falls in NH residents. The current proposal will develop an Injury Liason Service (ILS) intervention designed to promote deprescribing of psychoactive and cardiometabolic drugs AND encourage osteoporosis treatment. The intervention will address common barriers to fall prevention encountered in NH studies including fragmented communication. The following specific aims are proposed: 1) Develop an ILS care model designed to prevent injurious falls in NH residents using a) an automated risk calculator to identify high risk residents, b) centralized care coordination by an Injury Liaison Nurse, and c) videoconferencing with NH staff; 2) Test the ILS’ implementation-effectiveness in four NH facilities in residents with and without ADRD; and 3) Develop the protocol and resources for a phase 2 efficacy trial of the ILS model in 2-3 NH chains. The central hypothesis is that the ILS model will reduce injurious falls by changing care delivery through deprescribing and increased osteoporosis treatment. We hypothesize that implementation barriers are greater for residents with ADRD, and that it will require iterative intervention modifications to achieve adherence in this population. We will use experience-based co-design principles in Aim 1 to convene key stakeholders to transform the components of the intervention into a single, pragmatic care model that could be disseminated across NH systems. In Aim 2, we will implement the care model in four NH facilities. This will require programming the prediction model within the EMRs to identify high risk residents. A centralized ILS nurse will enact deprescribing recommendations and osteoporosis treatment among high risk residents (n~80) from a remote location. Videoconferencing will be used to facilitate education and communication. We will measure implementation success using post intervention measures of acceptability, demand, fidelity, and practicality. Effectiveness will be measured using process measures (e.g., medication dose reduction) using a pre-post design, and safety will be assessed using both pre-post measures from the Minimum Data Set (MDS) and chart review, stratified by ADRD status. In addition, we will validate the planned primary outcome for a future pragmatic trial, injurious falls ascertained from the MDS, with chart review. In Aim 3, we will develop the protocol and all materials needed for conducting an embedded pragmatic clinical trial of the ILS within 2-3 NH chains. The research team has considerable experience with NH research, including implementation science. At the completion of this study, we will have developed a robust care model that can be readily deployed by NH systems and evaluated for its impact on injurious falls in ADRD residents. We will be ideally positioned to conduct a pragmatic clinical trial embedded in NH systems to test the efficacy of the ILS. In addition to addressing injurious falls, this model has the potential to be modified for other complex geriatric syndromes in NH residents with ADRD.