Effectiveness and Implementation of Geriatrics Resources for Assessment and Care of Elders With HIV (GRACE-HIV) (GRACE-HIV)
The GRACE-HIV intervention is a 24-month intervention of RN care coordination guided by a multidisciplinary geriatric and HIV or "GRACE HIV" support team conducted in collaboration with a participant's health care team including any community service providers.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
The GRACE-HIV intervention is a 24-month intervention of RN care coordination guided by a multidisciplinary geriatric and HIV or "GRACE HIV" support team conducted in collaboration with a participant's health care team including any community service providers. The intervention is designed to integrate geriatric and HIV services to ensure older adults with HIV experiencing poverty receive appropriate and evidence based care for comorbid and geriatric conditions.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Eligible participants will be a) age 50 or older, b) receive HIV care (at least 1 visit at the same site within the past 12 months) from either Eskenazi Health IDC or LifeCare clinics, c) able to provide informed consent or have a legally authorized representative provide informed consent based on teach back processes described in recruitment procedures below , d) have a household income below 300% of the federal poverty level, and e) be English or Spanish speaking. The income criteria correspond to the eligibility criteria to receive Ryan White Services in Indiana.
Exclusion Criteria:
- We will exclude patients who are long-term nursing home residents as the nursing home team is their primary medical team and Ryan White funding does not support long term care services.
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Enkelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Eksperimentel: GRACE-HIV
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Each participant randomized to the intervention will undergo an initial visit at their home or preferred location, where the RN will conduct a comprehensive geriatric assessment including physical, cognitive, functional, psychosocial and community needs assessment, and a medication review including prescribed and over the counter medications. After the initial visit, the RN attends the weekly multidisciplinary team meeting to discuss the findings which trigger evidence-based geriatric HIV care protocols for inclusion in the personalized care plan. After multidisciplinary review, the RN will coordinate with the participant's HIV care team, and when relevant, with primary care, specialists, pharmacists, social workers, and community service organizations to refine and implement the care plan. |
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Ingen indgriben: Measure of Usual Care
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Health Related Quality of Life
Tidsramme: Baseline, 6month, 12 month, 18month and 24 month.
|
Medical Outcomes Short Form Survey36 (SF-36) to measure health related quality of life. The SF-36 includes eight scales measuring domains of physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and mental health. Our primary outcome measure is the Component Summary Scores |
Baseline, 6month, 12 month, 18month and 24 month.
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Geriatric Syndrome Identification and Management
Tidsramme: Baseline, 6month, 12 month, 18month and 24 month.
|
This outcome is a 24-month participant level Geriatric Syndrome Identification and Management Process Score, derived from EHR, medication, and referral data in both study arms. The composite will be defined as the number of eligible care processes completed divided by the number of eligible care processes during 24 months of follow-up. Components will include: (1) identification of key geriatric syndromes in the EHR, including falls/fall risk, depression, cognitive impairment or dementia, urinary incontinence, and polypharmacy and (2) management of identified syndromes, including medication reconciliation, syndrome-specific treatment or referral, prescribing of indicated medications such as antidepressants or dementia medications when clinically appropriate, and deprescribing of potentially inappropriate medications. Higher scores will indicate better delivery of recommended geriatric care processes. |
Baseline, 6month, 12 month, 18month and 24 month.
|
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Acute care healthcare utilization
Tidsramme: Baseline, 6month, 12 month, 18month and 24 month.
|
We will collect emergency department visits and hospitalization data from the Indiana Network for Patient Care, the health information exchange for the State of Indiana. |
Baseline, 6month, 12 month, 18month and 24 month.
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Datoer for undersøgelser
Studer store datoer
Studiestart (Anslået)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 32913
- 1R01AG102221-01 (U.S. NIH-bevilling/kontrakt)
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
Studerer et amerikansk FDA-reguleret lægemiddelprodukt
Studerer et amerikansk FDA-reguleret enhedsprodukt
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