Preparing Older Adults for Major Abdominal Surgery: a Systems Engineering Approach to Implement Preoperative Comprehensive Geriatric Assessments
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Implementation Package
研究概览
简要总结
The researchers will conduct observations, interviews, and focus groups with clinicians, staff and patients of the Perioperative Optimization of Senior Health (POSH) clinic, which conducts preoperative comprehensive geriatric assessments (pCGA) at UW Health to understand clinic processes and potential areas for improvement. The goal is to (1) create a process map describing clinic workflow and (2) redesign the process with healthcare providers and patients/families.
详细描述
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.
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Prospective
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •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
研究组 & 干预措施
Patients and caregivers
Patients attending the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Process Mapping: Observations (Other)
Patients and caregivers
Patients attending the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Process Mapping: Interviews (Other)
Patients and caregivers
Patients attending the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Participatory Design (Other)
Healthcare providers
Healthcare providers referring to or working in the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Process Mapping: Observations (Other)
Healthcare providers
Healthcare providers referring to or working in the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Process Mapping: Interviews (Other)
Healthcare providers
Healthcare providers referring to or working in the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Process Mapping: Focus Group (Other)
Healthcare providers
Healthcare providers referring to or working in the Perioperative Optimization of Senior Health (POSH) clinic
干预措施: Participatory Design (Other)
结局指标
主要结局
Implementation Package
时间窗: 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.
Process map
时间窗: 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.
次要结局
- Qualitative data: Barriers and Facilitators to preoperative comprehensive geriatric assessments(5 years)