The Care Ecosystem: Navigating patients and caregivers through stages of dementia care

护理生态系统：引导患者和护理人员完成痴呆症护理的各个阶段

• 批准号: 10158375
• 负责人: Katherine Laurel Possin
• 金额: $ 109.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10158375
• 关键词: Award; Behavior; Behavioral Symptoms; California; Caregiver Burden; Caregiver support; Caregivers; Caring; Cessation of life; Characteristics; Clinical; Communication; Communities; Complement; Consultations; Continuity of Patient Care; Day Care; Decision Making; Delirium; Dementia; Dementia caregivers; Dimensions; Disease; Economics; Ecosystem; Elements; Environment; Family; Funding; Health; Health Care Costs; Health Policy; Health system; Healthcare; Healthcare Systems; Hospitalization; Household; Iatrogenesis; Income; Individual; Internet; Iowa; Learning; Legal; Locales; Long-Term Care; Long-Term Effects; Longitudinal Studies; Measurement; Mediation; Medical; Medicare/Medicaid; Mental Depression; Modeling; Nebraska; Nurses; Nursing Homes; Online Systems; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Policies; Population Heterogeneity; Primary Health Care; Quality of life; Randomized; Randomized Controlled Trials; Reporting; Resources; Risk; Rural; Sampling; San Francisco; Self Efficacy; Severities; Social Well-Being; Social Work; Social Workers; Social isolation; Societies; Supervision; Symptoms; System; Telephone; Time; Training; beneficiary; care burden; care costs; care delivery; care outcomes; care systems; caregiver depression; caregiver education; cohort; cost; dementia care; design; economic outcome; end of life; end of life care; ethnic minority population; evidence base; falls; hospice environment; improved; innovation; medical complication; medical specialties; multiple chronic conditions; patient oriented; patient population; physical conditioning; premature; programs; psychosocial; rural residence; satisfaction; socioeconomics; suburb; treatment as usual; treatment effect; treatment response; trend

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients, their caregivers, and health care systems. Recent and potential changes in health care policy indicate a shift towards reimbursement models that could sustain evidence-based dementia care. Currently, there is a wide gap between best practice in dementia and real- world care delivery. Scalable, effective, and patient-centered dementia care models that are aligned with trends in reimbursement reform are needed now. The Care Ecosystem is a dementia support program that combines elements of effective programs into a scalable model that could be successful in the new policy environment. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a nurse, social worker, and pharmacist. Proactive care modules focus on caregiver support and education, medication consultation, support around medical, financial, and legal decisions, and behavior management. We are evaluating the short-term impact of the Care Ecosystem on psychosocial and economic outcomes in a randomized controlled trial, funded by the Centers for Medicare and Medicaid Innovation. Patients and caregivers from rural and urban locales, with a range of socioeconomic characteristics, and cohorts of Spanish and Cantonese speaking persons are included. Short-term (6 month) results suggest benefit, and we expect that the greatest impact of our care program will be realized in the long term across all stages of dementia. This proposed project would continue the care and measurement in our existing cohort to determine the 5-year treatment effects and to characterize the patients and caregivers most likely to benefit. In Aim 1, we will evaluate the Care Ecosystem's effects on patient quality of life, time to nursing home placement, cost of care, and caregiver burden, depression, and health across the disease trajectory. In Aim 2, we will determine the differential treatment effects by rural/urban locale, household income, ethnic minority status, and by severity of behavioral symptoms, caregiver burden, and social isolation. In Aim 3, we will determine the effects of Care Ecosystem on end of life care among patients who die. By clarifying the impacts of this scalable dementia care program, our project would provide important guidance as health systems determine what dementia care services to provide and to which beneficiaries. In addition, results would provide a framework for caring for a diverse population of patients and caregivers across the care continuum.

项目概要/摘要 痴呆症给患者、他们的护理人员和医疗保健系统带来沉重负担。最近和 医疗保健政策的潜在变化表明报销模式的转变可以维持 基于证据的痴呆症护理。目前，痴呆症的最佳实践与现实之间存在巨大差距 世界护理服务。可扩展、有效且以患者为中心的痴呆症护理模式与 现在需要报销改革的趋势。护理生态系统是一项痴呆症支持计划， 将有效计划的要素整合到一个可扩展的模型中，该模型可以在新政策中取得成功 环境。由未经许可的护理团队导航员通过电话和网络提供护理，他们经过培训 并由护士、社会工作者和药剂师监督。主动护理模块侧重于护理人员支持 教育、药物咨询、医疗、财务和法律决策以及行为方面的支持 管理。我们正在评估护理生态系统对社会心理和经济的短期影响 由医疗保险和医疗补助创新中心资助的随机对照试验的结果。 来自农村和城市地区的患者和护理人员，具有一系列社会经济特征，以及 其中包括讲西班牙语和粤语的人群。短期（6 个月）结果表明 受益，我们预计我们的护理计划的最大影响将在长期内实现 痴呆症的各个阶段。该拟议项目将继续对我们现有队列进行护理和测量，以 确定 5 年治疗效果并确定最有可能受益的患者和护理人员的特征。在 目标 1，我们将评估护理生态系统对患者生活质量、入住疗养院的时间、 整个疾病轨迹的护理成本、护理人员负担、抑郁和健康状况。在目标 2 中，我们将 确定农村/城市地区、家庭收入、少数民族状况的差别待遇效果，以及 根据行为症状的严重程度、照顾者负担和社会隔离。在目标 3 中，我们将确定 护理生态系统对死亡患者临终关怀的影响。通过阐明这种可扩展的影响 痴呆症护理计划，我们的项目将提供重要的指导，因为卫生系统决定什么 提供痴呆症护理服务以及受益人。此外，结果将为 在整个护理过程中照顾不同人群的患者和护理人员。

项目成果

Preprints During the COVID-19 Pandemic: Public Health Emergencies and Medical Literature.

COVID-19 大流行期间的预印本：突发公共卫生事件和医学文献。

• 发表时间: 2020
• 作者: Guterman, Elan L;Braunstein, Lior Z
• 通讯作者: Braunstein, Lior Z

COVID-19 severity and age increase the odds of delirium in hospitalized adults with confirmed SARS-CoV-2 infection: a cohort study.

COVID-19 的严重程度和年龄会增加确诊 SARS-CoV-2 感染的住院成人出现谵妄的几率：一项队列研究。

• 发表时间: 2022-02-28
• 影响因子: 4.4
• 作者: LaHue, Sara C;Escueta, Danielle P;Guterman, Elan L;Patel, Kanan;Harrison, Krista L;Boscardin, W John;Douglas, Vanja C;Newman, John C
• 通讯作者: Newman, John C

Long-term digital device-enabled monitoring of functional status: Implications for management of persons with Alzheimer's disease.

长期数字设备功能状态监测：对阿尔茨海默病患者管理的影响。

• 发表时间: 2020
• 作者: Manley, Natalie A;Bayen, Eléonore;Braley, Tamara L;Merrilees, Jennifer;Clark, Amy M;Zylstra, Bradley;Schaffer, Michael;Bayen, Alexandre M;Possin, Katherine L;Miller, Bruce L;Schenk, A Katrin;Bonasera, Stephen J
• 通讯作者: Bonasera, Stephen J

Implementation and review of the care ecosystem in an integrated healthcare system.

在综合医疗保健系统中实施和审查护理生态系统。

• 发表时间: 2023-08-24
• 影响因子: 4.1
• 作者: Rosenbloom, Michael H;Kashyap, Bhavani;Diaz;Karrmann, Jan;Svitak, Aleta;Finstad, Jennifer;Brombach, Ann;Sprandel, Ann;Hanson, Leah;Dulaney, Sarah;Possin, Katherine
• 通讯作者: Possin, Katherine

End-of-Life Experiences Within a Dementia Support Program During COVID-19: Context and Circumstances Surrounding Death During the Pandemic.

COVID-19 期间痴呆症支持计划中的临终经历：大流行期间死亡的背景和情况。

• 发表时间: 2023-07
• 作者: Brungardt, Adreanne;Cassidy, Jessica;LaRoche, Ashley;Dulaney, Sarah;Sawyer, R John;Possin, Katherine L;Lum, Hillary D
• 通讯作者: Lum, Hillary D