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Involving Nursing Home Residents and Their Families in Acute Care Transfer Decisions

2020년 8월 14일 업데이트: Ruth Tappen, Florida Atlantic University

Involving Nursing Home Residents and Their Families in Acute Transfer Decisions: Pilot Test of a New Decision Aid

This study addresses the Patient-Centered Outcomes Research Institute (PCORI) area of interest related to development of decision support tools that bring patients, families and clinicians together to decide, in this instance, whether or not transfer from the nursing home (NH) to acute care is necessary and appropriate. The purposes of this study were 1) to develop an evidence-based decision aid addressing potentially avoidable transfers of residents from nursing homes to hospitals (preceded this protocol), and 2) to evaluate this decision aid in terms of acceptability to residents and families and its effect on the quality of transfer decisions.

The primary hypotheses to be tested are:

Hypothesis 1: Resident and family members in the intervention group will report greater preparation for decision making and less decisional conflict than those in the no treatment control group.

Hypothesis 2: Residents and family members in the intervention group will demonstrate increased knowledge related to acute care transfer and less preference for acute care transfer than those in the no treatment control group.

연구 개요

상태

완전한

정황

개입 / 치료

상세 설명

Project Summary: The goal of this project is to develop (Phase I) and test (Phase II) a new Transfer Decision aid that will better prepare nursing home (NH) residents and their families to participate in decisions to transfer the resident to an acute care facility or remain in the NH for treatment.

Objectives: The specific aim of this study is to evaluate the decision aid, "Go to the Hospital or Stay Here?" in terms of acceptability to residents and families and its effect on decision making and transfer decisions by residents and families.

Study Design: A mixed methods design was used to address the study aims. In Phase I (not submitted to ClinicalTrials.gov), interviews of a diverse sample of NH residents, their family members, primary care providers, nurses and social workers in the NH were conducted and the results were used to create a Transfer Decision aid to be pilot tested in Phase II for its effect on decision making and transfer decisions.

Phase II involves a pretest, intervention for the half randomly selected to receive it, 14 day posttest and 90 day follow-up.

Study Population: Staff of 15 participating South Florida nursing homes (NHs) were asked to recommend residents and family members of residents who could participate in the study. Residents were tested for ability to provide consent using the Mini-Cog prior to enrollment.

General Analytic Strategy: Multiple linear regression (MLR) will be used to analyze the variance when predicting the primary and secondary outcome variables, preparation for decision making, decisional conflict, knowledge and number of transfers (McNeil, Newman & Kellee, 1996; Pedhazur & Schmelking, 1991). For qualitative data, Phase II interviews are transcribed and the transcriptions reviewed for accuracy. Responses were de-identified (names, gender and ethnic identity information removed). A framework for descriptive (labeling and categorizing), interpretive (based on underlying meaning) and pattern (thematic) codes was developed. Intercoder reliability was calculated.

연구 유형

중재적

등록 (실제)

192

단계

  • 해당 없음

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 장소

  • 미국
    • Florida
      • Boca Raton, Florida, 미국, 33431
        • Florida Atlantic University, Christine E. Lynn College of Nursing

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

21년 이상 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

Inclusion Criteria:

  • Adult nursing home resident and/or family member or identified significant other of a nursing home resident. Cognitively unimpaired individuals. Long or short term residents of nursing home or rehabilitation center.

Exclusion Criteria:

  • Dementia as indicated by score on Mini-Cog. Inability to respond to questions due to physical disability or illness.

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 치료
  • 할당: 무작위
  • 중재 모델: 병렬 할당
  • 마스킹: 하나의

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: Decision aid
Provision of "Go to the Hospital or Stay Here?"
행동: Provision of "Go to the Hospital or Stay Here?"
Residents and families randomly assigned to the intervention group (one half of the residents and one half of the families enrolled) are given the new Decision Aid to review with an RA trained for this purpose by the investigators. The Decision Aid provides information on risks and benefits of acute care transfer and information on advance care planning, resident and families' right to be involved in the decision. Resident or family member is also asked to re-read it and think about it over the subsequent 14 days.
다른 이름들:
  • Transfer Decision Guide
간섭 없음: No decision aid
Does not receive the decision aid.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
Preparation for Decision Making
기간: Decision Aid group only: Post test (2-3 weeks after pretest) and at 3 month follow-up (after post test)

Range of possible raw scores: 10 - 50. Items can be summed and scored (sum the 10 items and divide by 10).

There are no subscales. A higher score is positive indicating perception of being better prepared to make the decision identified when test is administered.
Decision Aid group only: Post test (2-3 weeks after pretest) and at 3 month follow-up (after post test)
Decisional Conflict Scale
기간: Decision aid: Pretest (baseline) and Post test (2-3 weeks after pretest); No decision aid: Post test only

Scale Range of possible raw scores: 0 - 64.

A lower score indicates less decisional conflict related to making the identified decision. Decisional conflict is a state of uncertainty about a course of action. Decision supporting interventions are thought to be effective in
Decision aid: Pretest (baseline) and Post test (2-3 weeks after pretest); No decision aid: Post test only

2차 결과 측정

결과 측정
측정값 설명
기간
Knowledge Test
기간: Pretest (baseline) and Post test (2-3 weeks after pretest)

Decision Aid Quiz Investigator Developed: True/False Test of Knowledge based upon information in the Decision Aid.

Scale Range: 0 - 22. Total score is the number of questions answered correct.

A higher score indicates greater number of responses are correct. Items are scored as 0 = incorrect; 1 = correct.

Criteria used to assess this measure:

Items based upon concept mapping of the Decision Aid Reviewed by a panel of experts prior to administration
Pretest (baseline) and Post test (2-3 weeks after pretest)
Treatment Preference/Decisional Conflict Scale
기간: Post test (2-3 weeks after pretest)
Treatment Site Option Preference Administered prior to the Decisional Conflict Scale, this single item was used to ask participants if they preferred treatment in the hospital or nursing home or if the preference depended upon the seriousness of their condition (three choices). This is nominal level data. The administration of the item precedes administration of the Decisional Conflict Scale (DCS) described previously. Standard administration of the Decision Conflict Scale includes this item but it is not part of the DCS score.
Post test (2-3 weeks after pretest)
30 Day Hospital Readmission
기간: Length of stay ≤30 days at Post test
Report of all hospitalizations from facility staff or participants Hospital Transfers Occurring During Study Period, i.e., number of resident participants who were hospitalized from pretest to posttest and by end of 3 month follow-up period.
Length of stay ≤30 days at Post test

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

스폰서

Florida Atlantic University

수사관

  • 수석 연구원: Ruth M. Tappen, EdD, RN, FAAN, Christine E. Lynn College of Nursing, Florida Atlantic University

간행물 및 유용한 링크

연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.

일반 간행물

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작

2012년 10월 1일

기본 완료 (실제)

2015년 9월 1일

연구 완료 (실제)

2015년 9월 1일

연구 등록 날짜

최초 제출

2015년 10월 2일

QC 기준을 충족하는 최초 제출

2015년 10월 5일

처음 게시됨 (추정)

2015년 10월 6일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2020년 8월 31일

QC 기준을 충족하는 마지막 업데이트 제출

2020년 8월 14일

마지막으로 확인됨

2020년 8월 1일

추가 정보

이 연구와 관련된 용어

키워드

추가 관련 MeSH 약관

기타 연구 ID 번호

  • 343268
  • 1IP2PI000281-01 (기타 보조금/기금 번호: Patient-Centered Outcomes Research Institute)

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