University of Maryland School of Nursing
Implementation of a Telehealth Palliative Care Model for Persons with Dementia
Health Care Systems
University of Maryland School of Nursing
Dr. Carpenter is an assistant professor at the University of Maryland School of Nursing and a health scientist at the Corporal Michael J. Crescenz VA Medical Center. Dr. Carpenter is a geriatric nurse practitioner, an advanced certified hospice and palliative care nurse, and fellow in palliative care nursing. She is an expert in geriatric palliative care, specializing in post-acute and long-term care settings. Her research interests focus on the implementation and evaluation of non-pharmacologic palliative care interventions to improve quality of life, reduce symptom burden, and enhance decision making for people with serious illness and their care partners in post-acute and long-term care. She has extensive experience collaborating with interdisciplinary health professionals in community skilled nursing facilities and Veterans Affairs community living centers to implement evidence-based practices and complex interventions to support high-quality palliative care. Her position as an educator, researcher, and leader supports national efforts to enhance serious illness care for older adults.
RATIONALE: People living with dementia (PLWD) receiving post-acute care in nursing homes (NHs) often receive treatments focused on intense rehabilitation and/or aggressive, disease-focused therapies. This has profound implications for quality of life and end-of-life experiences of PLWD. Palliative care consultation offers an evidence-based alternative for PLWD; it increases advance care planning, improves patient and care partner satisfaction, and reduces costs and acute care use.
OBJECTIVE: This pilot study will assess the implementation outcomes and fidelity of a Nurse Practitioner (NP)-delivered telehealth Palliative Care Consultation in Post-Acute Care (PCC-PAC) intervention. The evidence-based PCC-PAC is a multi-component non-pharmacologic, NP-delivered intervention designed to meet the needs of PLWD receiving post-acute care in NHs.
SETTING: One nursing home located in the northeast United States.
POPULATION: PLWD and their care partners newly admitted to NHs for post-acute care following a recent hospitalization.
DESIGN: Single arm pilot study for an embedded pragmatic clinical trial (ePCT)
OUTCOMES: The acceptability, appropriateness, and NP and NH fidelity to the telehealth delivered PCC-PAC.
IMPACT: Embedding complex interventions in NHs is challenging and requires addressing barriers to adopting new practices as well as effective implementation. Findings from this study will immediately inform refinements of the telehealth PCC-PAC and prepare the team for testing the PCC-PAC in a large-scale effectiveness/implementation cluster, randomized ePCT.