背景:美国老年人,越来越多的人口,对外科服务的需求不断增加,与年轻人相比,他们经历了不成比例的术后并发症负担。建议进行术前综合老年评估(pCGA),以降低风险并改善该人群的手术护理。被认为是脆弱的。pCGA优化了常规术前计划中通常忽略的多种慢性疾病和因素,包括身体功能,多药,营养,认知,心理健康,社会和环境支持。pCGA已被证明可以降低术后发病率,死亡率,以及在各种外科专业的住院时间。尽管国家指南建议使用pCGA,缺乏实施的战略指导限制了其对少数学术医学中心的吸收。通过应用实施科学和人为因素工程方法,这项研究将为优化pCGA在各种医疗机构中的实施提供必要的证据.
目的:本文的目的是描述研究方案,以设计一种可适应的,以用户为中心的pCGA实施包,适用于腹部大手术前的老年人。
方法:该协议使用系统工程方法来开发,裁缝,并对以用户为中心的pCGA实施包进行试点测试,可以适应社区医院,为多地点实施试验做准备。该协议基于美国国立卫生研究院的行为干预发展阶段模型,并与着眼于现实世界实施的行为干预发展目标保持一致。在第1阶段,我们将使用观察和访谈来绘制pCGA过程,并确定在接受大型腹部手术的老年人中使用基于系统的障碍和促进因素。在第二阶段,我们将应用以用户为中心的设计方法,参与医疗保健提供者,病人,和护理人员共同设计pCGA实施包。该软件包将适用于在大型学术医院和附属社区站点接受大型腹部手术的老年患者的多样化人群。在第3阶段,我们将对pCGA实施软件包进行试点测试和完善,为未来的随机对照实施有效性试验做准备。我们预计这项研究将需要大约60个月(2023年4月至2028年3月)。
结果:该研究方案将生成(1)pCGA的详细过程图;(2)适应性,以用户为中心的pCGA实施软件包,可在试点试验中进行可行性测试;(3)有关该软件包的实施和有效性的初步试点数据。我们预计这些数据将作为未来在接受大型腹部手术的老年人中pCGA的多点混合实施有效性临床试验的基础。
结论:本研究的预期结果将有助于改善老年人腹部大手术前的围手术期护理流程。
■DERR1-10.2196/59428。
BACKGROUND: Older Americans, a growing segment of the population, have an increasing need for surgical services, and they experience a disproportionate burden of postoperative complications compared to their younger counterparts. A preoperative comprehensive geriatric assessment (pCGA) is recommended to reduce risk and improve surgical care delivery for this population, which has been identified as vulnerable. The pCGA optimizes multiple chronic conditions and factors commonly overlooked in routine preoperative planning, including physical function, polypharmacy, nutrition, cognition, mental health, and social and environmental support. The pCGA has been shown to decrease postoperative morbidity, mortality, and length of stay in a variety of surgical specialties. Although national guidelines recommend the use of the pCGA, a paucity of strategic guidance for implementation limits its uptake to a few academic medical centers. By applying implementation science and human factors engineering methods, this
study will provide the necessary evidence to optimize the implementation of the pCGA in a variety of health care settings.
OBJECTIVE: The purpose of this paper is to describe the study protocol to design an adaptable, user-centered pCGA implementation package for use among older adults before major abdominal surgery.
METHODS: This protocol uses systems engineering methods to develop, tailor, and pilot-test a user-centered pCGA implementation package, which can be adapted to community-based hospitals in preparation for a multisite implementation
trial. The protocol is based upon the National Institutes of Health Stage Model for Behavioral Intervention Development and aligns with the goal to develop behavioral interventions with an eye to real-world implementation. In phase 1, we will use observation and interviews to map the pCGA process and identify system-based barriers and facilitators to its use among older adults undergoing major abdominal surgery. In phase 2, we will apply user-centered design methods, engaging health care providers, patients, and caregivers to co-design a pCGA implementation package. This package will be applicable to a diverse population of older patients undergoing major abdominal surgery at a large academic hospital and an affiliate community site. In phase 3, we will pilot-test and refine the pCGA implementation package in preparation for a future randomized controlled implementation-effectiveness
trial. We anticipate that this
study will take approximately 60 months (April 2023-March 2028).
RESULTS: This study protocol will generate (1) a detailed process map of the pCGA; (2) an adaptable, user-centered pCGA implementation package ready for feasibility testing in a pilot
trial; and (3) preliminary pilot data on the implementation and effectiveness of the package. We anticipate that these data will serve as the basis for future multisite hybrid implementation-effectiveness clinical trials of the pCGA in older adults undergoing major abdominal surgery.
CONCLUSIONS: The expected results of this study will contribute to improving perioperative care processes for older adults before major abdominal surgery.
UNASSIGNED: DERR1-10.2196/59428.