- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06184919
Preparing Older Adults for Major Surgery With Preoperative Comprehensive Geriatric Assessments
Preparing Older Adults for Major Abdominal Surgery: a Systems Engineering Approach to Implement Preoperative Comprehensive Geriatric Assessments
Study Overview
Status
Conditions
Detailed Description
Aim 1: Process mapping using direct observation, interviews and focus groups to identify opportunities for system redesign
The research team will directly observe n=30 patients in POSH clinic visits, taking notes and documenting the persons, tasks, tools/technologies, environment and organizational factors affecting healthcare delivery. Observer notes will be supplemented with audio recording of the clinic visit. Observations will also include assessments performed by social workers, pharmacist, medical assistants.
Semi-structured qualitative interviews with patients who participated in the observations and their caregivers, if any, will be conducted 2 weeks after the pCGA visit. Interviewers will assess barriers, facilitators, motivation, and adherence to tasks, and reflections on the process of scheduling, attending and participating in the clinic. Surgeons who refer patients (n=20) will be interviewed using semi-structured guides to elicit feedback on the process map and explore perceived barriers and facilitators to adoption of the pCGA.
Focus Groups: Healthcare professionals and staff (n=20) who conduct the pcga will participate in a focus group to provide feedback on the process map. The researchers will elicit feedback on the process map, clarifying its accuracy as a representation of the tasks and procedures performed, and identifying system-level barriers and facilitators at each step.
Aim 2: Co-design an implementation package for the pCGA at (2a) a large academic hospital and (2b) an affiliate community site.
The research team will apply user-centered participatory design methods to adapt the process map (aim 1) into an implementation package, which consists of a set of implementation strategies, to address barriers and enhance facilitators at each step. Participatory design (also called "co-design") is a systems engineering approach where the researchers and participants work together in designing the workflow of an intervention. Co-design sessions will be conducted in parallel at our University Hospital (2a) and a local affiliated community hospital (2b). There will be two groups (design teams) of patients/caregivers and healthcare professionals per location, for a total of four groups.
This study will include five co-design videoconference sessions with up to n=10 members in each group (total n=40) over approximately 6 months, with 2-3 weeks between each session. Each session will last 90 minutes. The sessions will identify process changes that can address barriers and facilitators to promote implementation of the pCGA. The research team will analyze audio recordings and notes from each session. These findings will be synthesized and presented at the next design session. Each design team will participate in sessions independently, however, the research team will summarize output from each session and provide this content to the alternate design team for comment.
Design sessions are expected to generate an implementation package that is ready for feasibility and pilot testing at the University hospital. Design sessions at the community site will serve as a template for implementation at a future date.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Locations
-
-
Wisconsin
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Madison, Wisconsin, United States, 53792
- UW Hospital and Clinics
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Being a patient seen for a pCGA clinic at the time of observations, or being the caregiver of such a patient.
- Being a clinician or staff member working at the pCGA clinic
- Being a surgeon who frequently refers patients to the pCGA clinic
Exclusion Criteria:
For patients:
- not being fluent in English
- having an enacted power of attorney indicating that the patient is unable to make medical decisions for themselves and a legally authorized representative (LAR) does not attend the pCGA visit with the patient
- For pCGA clinicians and staff: none
- For surgeons: none
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Patients and caregivers
Patients attending the Perioperative Optimization of Senior Health (POSH) clinic
|
Direct observations of the POSH clinic visit.
Semi-structured interviews of patients and providers involved in the POSH clinic.
Participatory design, also called "co-design" is a systems engineering approach where the researchers and participants work together in designing the workflow of an intervention.
There will be two groups (design teams) of patients/caregivers and healthcare professionals per location, for a total of four groups.
|
Healthcare providers
Healthcare providers referring to or working in the Perioperative Optimization of Senior Health (POSH) clinic
|
Direct observations of the POSH clinic visit.
Semi-structured interviews of patients and providers involved in the POSH clinic.
Participatory design, also called "co-design" is a systems engineering approach where the researchers and participants work together in designing the workflow of an intervention.
There will be two groups (design teams) of patients/caregivers and healthcare professionals per location, for a total of four groups.
Focus group of providers and staff who conduct the POSH clinic.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Process map
Time Frame: 12 months
|
The direct observations, interviews and focus groups conducted with patients and caregivers will help create a detailed process map of preoperative geriatric assessments.
Specifically this map will detail the persons, tasks, tools/technologies, environment and organizational factors involved in the process according to the System Engineering Initiative for Patient Safety model.
|
12 months
|
Implementation Package
Time Frame: 24 months
|
Co-design sessions will generate an implementation package, consisting of a set of implementation strategies, that can be piloted for its feasibility and adapted to facilitate preoperative comprehensive geriatric assessment in other settings.
|
24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Qualitative data: Barriers and Facilitators to preoperative comprehensive geriatric assessments
Time Frame: 5 years
|
The qualitative analysis performed of interviews and focus groups during process mapping will identify barriers and facilitators to the use of preoperative comprehensive geriatric assessments.
|
5 years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Julia R Berian, MD, University of Wisconsin, Madison
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2022-1516
- A539707 (Other Identifier: UW Madison)
- SMPH/SURGERY/COLON RECT (Other Identifier: UW Madison)
- 1K23AG081487-01 (U.S. NIH Grant/Contract)
- 2024-0044 [Aim 2] (Other Identifier: UW Madison)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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