Development and pilot testing of a novel text messaging intervention to improve emergency department care transitions among care partners of persons living with cognitive impairment

About This Grant

PROJECT SUMMARY/ABSTRACT The majority of persons living with cognitive impairment (PLWCI) are discharged after seeking care in the emergency department (ED), with informal care partners (e.g. family members, friends) subsequently providing a significant amount of hands-on care and navigation of health-related and social needs within this vulnerable time period. There exists a critical need to develop pragmatic ED care transition interventions to support care partners given the growing population of PLWCI seeking emergency care, the adverse outcomes that PLWCI experience after ED discharge, the outcome interconnectedness between PLWCI and care partners, and the limited generalizability and effectiveness of interventions to date. The candidate, Dr. Gettel, is an emergency physician at the Yale School of Medicine with a track record of early success and preliminary findings through an NIA GEMSSTAR Award identifying that care partners of PLWCI experienced poor, if any, communication during ED discharge. Digital health interventions (e.g. text messaging) have previously shown promise as a pragmatic tool for communication in various ED populations, yet no evaluations have assessed these approaches in the population of care partners of PLWCI despite their acceptance of digital health and the capability of digital health tools to disseminate information beyond the physical confines of the ED encounter. The objective of this proposal is to develop and pilot test the CAre Partner Text message intervention to improve futURE outcomes (CAPTURE), an ED care transition intervention delivered via automated tailored text messaging that will provide information, core medical reminders and behavioral strategies, and practical support to care partners of PLWCI. Sequential exploratory mixed-methods approach will be used to achieve the three aims: 1) Elucidate facilitators and barriers to the use of an ED-based text message care transition intervention among care partners of PLWCI; 2) Develop and iteratively refine the CAPTURE using user- centered design methods for care partners of PLWCI quantitatively measuring usability, feasibility, and acceptability; and 3) Determine the feasibility and preliminary efficacy of the CAPTURE implementation after an ED visit in care partners of PLWCI compared to a care partner population receiving usual care. Responsive to the “National Institute on Aging: Strategic Directions for Research, 2020-2025”, findings of this proposal will expand supports and address the special needs of care partners of PLWCI. During the award period, Dr. Gettel will pursue career development training activities leveraging the team’s mentorship expertise in the domains of: geriatric emergency medicine; text message interventions; ADRD and care partners; patient- and caregiver-reported outcome (PCRO) measurement; embedded pragmatic clinical trial (PCT) design; and implementation science. Findings will inform an NIA R01 proposal to assess the real-world efficacy and effectiveness of the CAPTURE implementation and its impact on PCROs as part of a multisite embedded PCT.