Many vulnerable, high-risk nursing home (NH) residents often lack access to appropriate and timely palliative care expertise and support in the NH setting, frequently leading to burdensome transitions, particularly at the end of life. Growing workforce challenges will not allow for traditional solutions to this problem. It is therefore critical to examine and promote change at the intersection of healthcare systems by using technology to improve palliative care access to hard to reach NH populations. Such research that comprehensively addresses the impact of system-level interventions can significantly advance the field of structural interventions to improve patient health quality and access, as well as decrease healthcare costs.
This K76 Paul B. Beeson Emerging Leaders Career Development Award in Aging proposes to provide Dr. Caroline Stephens, a newly promoted Associate Professor in the UCSF School of Nursing, with mentorship and training in translational qualitative research, implementation science, clinical trials, and leadership development. The proposed training and support will provide her with the necessary additional skills to become a transformative interdisciplinary leader in aging and palliative care research who examines and promotes changes at the junctures of healthcare systems to improve access to palliative care services and supports for hard to reach nursing home (NH) populations. She has assembled an excellent multidisciplinary team of mentors and scientific advisors with the following areas of expertise: clinical geriatrics and palliative care (Drs. Christine Ritchie and Sei Lee); implementation science (Drs. C. Ritchie and S. Lee); integrated care delivery models for frail elders (Dr. C. Ritchie and L. Branagan); measuring and improving health care quality in NHs (Drs. S. Lee, Charlene Harrington, Joseph Ouslander); developing/evaluating patient-centered technologies, such as telehealth, for improving care for medically complex older adults (Drs. C. Ritchie and L. Branagan); statistical expertise on clinical trial design and analysis of complex datasets (Dr. J. Neuhaus); long term care health policy (Dr. C. Harrington); translational qualitative research methods (Dr. J. Shim); developing, testing and evaluating multi- component interventions in the NH setting (Dr. J. Ouslander). Suboptimal communication and lack of access to appropriate and timely palliative care expertise and support in the NH setting often leads to burdensome transitions, particularly at the end of life. Dr. Stephens' research will focus on developing, optimizing and pilot-testing a multi-component Improving Access Through Technology (ImPAcTT) intervention that leverages existing telehealth technologies to provide staff education; family outreach, engagement and support; care coordination; and resident symptom management and facilitation of goals-of-care discussion. ImPAcTT employs a secure communications platform that permits multi- person live video, audio, and text message consultations; real-time document sharing and documentation for advanced care planning discussions; and remote virtual assessment capabilities. In Aim 1, she will conduct semi-structured interviews with NH staff, residents and families to explore potential barriers and facilitators to using telehealth for increasing upstream access to PC expertise, support, and education. In Aim 2, she will assess the technical feasibility of telehealth to provide NH palliative care education and support, and develop and refine study protocols with up to 10 NH residents, families and staff. In Aim 3, she will conduct a pilot implementation trial in 3 NHs to evaluate the feasibility and acceptability of the multi-component ImPAcTT intervention. These studies will provide the scientific foundation for a compelling R01 application to evaluate the outcomes of this ImPAcTT intervention in a multi-site RCT.