评估一个实用的试点和全面试验的可行性、可接受性和有效性,以改善具有复杂护理需求的老年人的护理:SPIRE研究。

IF 1.9 3区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL
Thomas Travison, Edward Pham, Karen Donelan, Stephen Bartels, Jocelyn Carter, Katie Corelli, Steven Counsell, Carie U Michael, Maggie Crean, Ellen Flaherty, Harvey Murff, Jen Perloff, Christine S Ritchie
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引用次数: 0

摘要

有复杂健康和社会护理需求的老年人约占美国人口的5%,但却贡献了大约一半的医疗费用。定性研究中的患者和护理者观点强调传统护理交付模式中的护理碎片化。这些老年人迫切需要更加精简和个性化的护理,特别是在以价值为基础的护理系统中,如负责任的护理组织(ACOs)。先前的研究表明,有复杂健康需求的老年人最好通过跨学科医疗保健专业人员团队实施的以人为本的护理计划来照顾,但采用仍然是次优的。在这项研究中,我们比较了两种不同的老年人护理方法:年度健康访问(AWV)和/或与GRACE(老年人评估和护理的老年资源)相结合的AWV。awv是一项具有简短老年评估的医疗保险福利;GRACE是一种老年护理模式,使用以家庭为基础的老年评估、结构化协议、团队为基础的护理计划和初级保健共同管理来支持有复杂护理需求的老年人。该研究分为两阶段,包括第一阶段可行性试点,在一个卫生系统的两个初级保健实践中进行;以及在4个aco的32个初级保健实践中进行的2期集群随机试验。第二阶段评估AWV与GRACE AWV的比较效果,主要结果是住院和患者体验,次要结果是护理人员压力和临床医生专业履行。结果将有助于为具有复杂健康需求的老年人提供个性化护理。NCT06287801。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessing the feasibility, acceptability, and efficacy of a pragmatic pilot and full-scale trial to improve care for older adults with complex care needs: The SPIRE study.

Older adults with complex health and social care needs comprise some 5 % of the United States population but contribute to roughly half of healthcare costs. Patient and caregiver perspectives in qualitative studies emphasize care fragmentation in traditional care delivery models. The need for more streamlined and personalized care for these older adults is acute, particularly in value-based care systems such as Accountable Care Organizations (ACOs). Prior studies suggest that older adults with complex health needs are best cared for through person-centered care plans conducted by interdisciplinary teams of healthcare professionals, but adoption remains suboptimal. In this study, we compare two different geriatric-focused approaches to care for older adults: Annual Wellness Visits (AWV) and/or AWV augmented with GRACE (Geriatric Resources for Assessment and Care of Elders). AWVs are a Medicare benefit with a brief geriatric assessment; GRACE is a geriatric model of care that uses a home-based geriatric assessment, structured protocols, team-based care planning and primary care co-management to support older adults with complex care needs. The two-phase study includes a Phase 1 feasibility pilot, conducted in two primary care practices in one health system; and a Phase 2 cluster-randomized trial conducted in 32 primary care practices in four ACOs. Phase 2 assesses the comparative effectiveness of AWVs vs. AWV with GRACE, with primary outcomes of hospitalizations and patient experience, and secondary outcomes of caregiver strain and clinician professional fulfillment. Results will help inform personalized care among older adults with complex health needs. NCT06287801.

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来源期刊
CiteScore
3.70
自引率
4.50%
发文量
281
审稿时长
44 days
期刊介绍: Contemporary Clinical Trials is an international peer reviewed journal that publishes manuscripts pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from disciplines including medicine, biostatistics, epidemiology, computer science, management science, behavioural science, pharmaceutical science, and bioethics. Full-length papers and short communications not exceeding 1,500 words, as well as systemic reviews of clinical trials and methodologies will be published. Perspectives/commentaries on current issues and the impact of clinical trials on the practice of medicine and health policy are also welcome.
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