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

项目摘要 这是Kei Ouchi，MD，MPH，MS为Paul B重新提交的。Beeson新兴领导者职业生涯 老龄化发展奖（K76）。大内博士致力于引领急诊医学领域整合 老年医学和姑息疗法的原理大内医生是一名急诊医生和家庭医院 布里格姆急诊医学部的一名医生（在病人家中提供住院治疗） 和妇女医院/哈佛医学院。大内博士的研究重点是艾德目标的开发， 在急诊科（艾德）进行的6分钟动机访谈，让患者参与 解决与门诊临床医生的高级护理计划（ACP）对话，并避免时间- 在时间紧迫的艾德环境中进行耗时、敏感的谈话。由NIA资助 GEMSSTAR R 03和急诊医学基金会，大内博士开发了艾德目标，并展示了其 艾德目标也可以增加患者的自我- 在离开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，艾德目标需要改进，以最大限度地发挥其潜在功效。 这项研究将完善艾德目标，以最大限度地发挥其潜在的功效和可扩展性，并确定初步的 改进后的艾德目标在离开艾德一个月后提高ACP参与度的功效。拟议的 5-一个为期一年的培训计划加速了大内博士作为一名独立的医学科学家的职业发展， 培训：1）认知障碍评估和护理人员参与ACP研究（艾德GOALCG）; 2)由经过专门培训的护士对艾德GOAL/艾德GOALCG进行改编; 3）进行艾德GOAL/ 艾德GOALCG由受过专门训练的护士管理;以及4）实施科学，为未来做好准备 艾德GOAL/艾德GOALCG的实用性临床试验。James Tulsky，医学博士，国际公认的研究员 和姑息医学的领导者将担任主要导师。大内博士的共同导师是：1）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;和2）Edward Boyer，医学博士，博士， K24资助的急诊医学研究员，在行为干预方面具有专业知识。这一切的高潮 职业发展奖将确保大内博士获得先进的研究技能和知识，他 需要对艾德目标进行一次大规模的、务实的试验。最终目标是将艾德目标确立为 国家护理标准，以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。大内博士的目标是扩大以ED为基础的护理范围，从急性，疾病- 定向护理（例如，枪伤）以包括以病人为中心的护理（例如，基于价值观的临终关怀） 通过整合老年医学和姑息医学原则，为重病的老年人提供服务。

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.