The Role of Visit Audio Recordings in Triadic Dementia Care

探访录音在三元痴呆护理中的作用

基本信息

批准号：
10437386
负责人：
PAUL JAMES BARR
金额：
$ 85.86万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-15 至 2027-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10437386
关键词：
Accountability Address Adherence Age Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulatory Care Facilities Behavior Caring Clinic Clinic Visits Clinical Communication Communities Computer software Data Decision Making Dementia Effectiveness Emotional Family Federally Qualified Health Center Feedback Funding Future Geography Goals Health Health Services Information Management Intervention Interview Knowledge Lebanon Linguistics Logistics Maps Methods Modeling Motivation Natural Language Processing Observational Study Outcome Patient Care Patient Preferences Patients Performance Personal Communication Persons Play Primary Health Care Process Provider Quality of life Readiness Recommendation Reporting Research Resources Role Roter Rural Sampling Schedule Site Structure System Systems Analysis Techniques Triad Acrylic Resin Trust United States National Institutes of Health Visit Work acceptability and feasibility aged arm behavior change behavior change wheel cognitive load dementia care design evidence base experience follow-up improved improved outcome information processing innovation novel open label pilot trial prospective psychosocial racial and ethnic satisfaction skills software development theories therapy design tool trustworthiness usability

项目摘要

PROJECT SUMMARY One in nine people aged 65 or older in the US lives with Alzheimer's disease (AD) or Alzheimer's disease-related dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits for dementia information, management, and community referrals. Quality interpersonal communication is associated with improved health-related outcomes. Models of triadic interactions purport that information exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to effective interpersonal communication. However, the degree to which effective interpersonal communication is achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application is unexplored in dementia. The objective of this proposal is to design an intervention that enhances interpersonal communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their visit recording platform, HealthPAL, which leverages natural language processing to structure visit information. The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of 200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD. Applicants hypothesize: 1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2) HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for behavior change will be identified using quantitative assessment of interpersonal communication during triadic visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on interpersonal communication in triadic AD/ADRD visits. This work is a necessary first step to improving PLWD triadic care by identifying behaviors that impact interpersonal communication and their associations with health- related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.

项目摘要在美国，有九分65岁以上的人患有阿尔茨海默氏病（AD）或阿尔茨海默氏病有关痴呆症（ADRD）。患有痴呆症（PLWD）及其护理伙伴的患者依靠初级保健诊所就诊用于痴呆信息，管理和社区推荐。质量人际关系是与改善与健康相关的结果有关。三合会互动的模型声称信息在目标设定和决策方面的交流，融洽以及患者和护理伙伴的参与是有效的人际交往。但是，有效的人际交往的程度是在三合会访问期间实现的是未知，很少有干预措施支持它。使用录音诊所就诊是一种基于证据的新型策略，具有支持三合会相互作用的潜力，但其应用在痴呆症中是出乎意料的。该建议的目的是设计一种增强人际关系的干预措施使用访问记录进行三合会访问中的交流。申请人将遵循NIH舞台模型重新设计其访问录音平台，HealthPal，该平台利用自然语言处理来构建访问信息。具体目的是：AIM 1（阶段0）：进行前瞻性观察性研究，门诊就诊记录了200个三合会（PLWD/CARE合作伙伴/临床医生）的音频12个月； 1.A.检查人际关系互动在三元广告/ADRD访问和与健康有关的结果中； 1.B.识别障碍和可以在三元广告/ADRD访问中进行人际交流； AIM 2（第1A阶段）：适应HealthPal 增强三元广告/ADRD访问中的人际交流；和目标3（阶段1b）：演示 HealthPal在AD/ADRD中的可用性，可行性，可接受性和潜在有效性。申请人假设： 1）来自人际关系沟通模型的结构将与与健康相关的结果相关联； 2） HealthPal将超出二元组和临床医生的可用性，可行性和可接受性指标。在AIM 1申请人中将使用爆炸性的顺序混合方法设计。由行为改变轮告知，目标通过对三合会期间人际交流的定量评估，将确定行为改变访问（每年200次，3次，3次访问；约600次访问），并通过半结构化访谈补充 1A三合会的样本（n = 42）;在AIM 2中，我们将使用参与设计方法（n = 60）重新设计HealthPal 使用AIM 1的发现；在AIM 3中，我们将使用开放标签，单臂，多站点试验试验（n = 30）确定HealthPal的可用性，可行性和可接受性，并收集有关其影响的初步数据三合会广告/ADRD访问中的人际交流。这项工作是改善PLWD的必要第一步通过确定影响人际交往及其与健康的关联的行为，通过确定三合会护理相关结果。开发了干预措施，并收集了广泛的数据，将作为一个强大的可以利用的资源来解决与PLWD护理有关的临床知识中的其他差距。