Hospital GamePlan4Care: A Web-Based Delivery System for Dementia Caregiver Support

Hospital GamePlan4Care：基于网络的痴呆症护理人员支持交付系统

基本信息

批准号：
10299720
负责人：
Molly Jane Horstman
金额：
--
依托单位：
MICHAEL E DEBAKEY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-10-01 至 2026-09-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10299720
关键词：
Acute Address Adult Adverse event Alzheimer&apos s disease caregiver Alzheimer&apos s disease related dementia Ambulatory Care Anxiety Area Award Caregiver Burden Caregiver support Caregivers Caring Chronic Cognitive Communities Data Delirium Dementia Dementia caregivers Development E-learning Education Elderly Emotional Ensure Event Evidence based intervention Family Family Caregiver Friends Future Geriatrics Goals Health Health Services Health Status Health education Healthcare Systems Home Hospital Design Hospitalists Hospitalization Hospitals Human Inpatients Intervention Interview Lead Learning Measures Medical center Medicine Mental Depression Mentors Mollies National Institute on Aging Online Systems Outcome Outcome Measure Outpatients Patient-Focused Outcomes Personal Satisfaction Physicians Problem behavior Randomized Randomized Controlled Trials Reporting Research Research Methodology Research Personnel Research Priority Resources Risk Role Sample Size Schedule Scientist Self Care Sentinel Site Social support Specialist Stroke Structure System Testing Therapeutic Training Training Support Translating Veterans Veterans Health Administration acceptability and feasibility acute care acute stress arm care giving burden care recipients career development caregiver depression caregiving dementia care dementia caregiving design efficacy testing evidence base experience falls family support hospital readmission implementation science improved outcome loved ones mortality multi-component intervention multidisciplinary novel primary outcome programs recruit retention rate skills training therapy design web-based intervention

项目摘要

This is a Mentored Physician-Scientist Award in Alzheimer’s Disease and Related Dementias (ADRD) application for Dr. Molly Horstman, a hospitalist and health services researcher at the Michael E. DeBakey VA Medical Center, who is establishing herself as a young investigator at the intersection of hospital medicine, dementia, and caregiving. This award will provide Dr. Horstman with the necessary support (1) to develop expertise in ADRD and dementia caregiving, (2) to receive formal training in implementation science research methods, and (3) to gain the experience needed to establish herself as an independent physician-scientist. To achieve these goals, Dr. Horstman has assembled a multidisciplinary mentoring team of nationally recognized investigators in ADRD, Dementia Caregiving, Geriatrics, and Implementation Science research methods. Hospital admissions are sentinel events for Veterans with ADRD and their family caregivers. Adults with ADRD are often discharged from the hospital with new functional and cognitive limitations, which increases demands on family caregivers following discharge. These changing caregiver demands increase caregiver stress, which can lead to worse outcomes for caregivers and care recipients. Over 20 years of research has demonstrated that care transitions interventions started in the hospital can improve outcomes for patients. Furthermore, care transitions interventions started in the hospital and designed specifically to meet the needs of stroke caregivers have been shown to reduce caregiver burden and anxiety and reduce acute care resource use following discharge. To date, this evidence base supporting tailored interventions to meet specific caregiver needs has not been translated to the support for dementia caregivers during care transitions. Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) is a multicomponent, evidence-based ADRD caregiver support program that has been adapted and implemented in the Veterans Health Administration as REACH VA. When delivered in the community, REACH II and REACH VA were associated with improvements in caregiver depression, caregiver social support, and caregiver self-care and a decrease in caregiver burden and problem behaviors in the care recipient. Evidence-based interventions, like REACH II, are challenging to scale and spread due to the need for one-on-one interactions between caregivers and dementia care specialists for skills training. GamePlan4Care (GP4C) is a novel, web-based training platform designed to fully replicate the core components of REACH II in an acceptable and scalable online platform informed by user-centered testing. With adaptation to the hospital setting to include care transitions training, GP4C has great potential to transform the support of ADRD caregivers during care transitions. This proposal will combine evidence-informed care transitions training with an existing dementia caregiver support intervention to create a new and unique intervention: Hospital GP4C. Using a Planned Adaptation Approach, we will build on the existing GP4C platform to incorporate the robust evidence supporting tailored care transitions training and support. The aims are to: 1) adapt GP4C for hospital care (Hospital GP4C), 2) evaluate the feasibility and acceptability of the Hospital GP4C intervention, and 3) to evaluate caregiver- reported outcomes and retention rates in a pilot randomized study of Hospital GP4C compared to health education. In Aim 1, semi-structured interviews with caregivers and staff will be used to inform the planned adaptation of GP4C for hospital care. Human-centered design will be used to develop care transitions specific content to supplement existing GP4C content. In Aim 2, quantitative and qualitative data will be collected to assess the feasibility and acceptability of Hospital GP4C. In Aim 3, a single site pilot randomized study of Hospital GP4C compared to a health education control will be conducted. Caregivers will be recruited in the hospital. The results of this award will inform a VA Merit Award for a multisite randomized controlled trial of Hospital GP4C.

这是阿尔茨海默病和相关痴呆症 (ADRD) 领域的指导医师科学家奖莫莉·霍斯特曼 (Molly Horstman) 博士的申请，她是弗吉尼亚州迈克尔·E·德贝基 (Michael E. DeBakey) 医院的住院医生和卫生服务研究员医疗中心，正在将自己定位为医院医学交叉领域的年轻研究者，该奖项将为霍斯特曼博士提供必要的支持 (1) 来发展。 ADRD 和痴呆症护理方面的专业知识，(2) 接受实施科学研究的正式培训方法，以及（3）获得将自己确立为独立医师科学家所需的经验。为了实现这些目标，霍斯特曼博士组建了一支由国家认可的多学科指导团队 ADRD、痴呆症护理、老年病学和实施科学研究方法的研究人员。对于患有 ADRD 的退伍军人及其家庭护理人员来说，入院是前哨事件。 ADRD 出院后往往会出现新的功能和认知限制，这增加了出院后对家庭护理人员的要求这些变化的护理人员需求增加了护理人员。 20 多年的研究表明，压力可能会导致护理人员和护理接受者的结果更糟。在医院开始的护理转变干预措施可以改善患者的治疗结果。此外，护理过渡干预措施从医院开始，专门为满足需求而设计的中风护理人员已被证明可以减轻护理人员的负担和焦虑，并减少急性护理资源迄今为止，该证据基础支持定制干预措施以满足特定要求。护理人员的需求尚未转化为在护理过渡期间对痴呆症护理人员的支持。增强阿尔茨海默病护理人员健康的资源 (REACH II) 是一个多组成部分、基于证据的项目 ADRD 护理人员支持计划已在退伍军人健康中心进行调整和实施作为 REACH VA 进行管理当在社区中提供时，REACH II 和 REACH VA 是相关联的。随着照料者抑郁、照料者社会支持和照料者自我护理的改善，以及照料者抑郁症的减少基于证据的干预措施，例如 REACH II，由于护理人员和护理人员之间需要一对一的互动，因此难以规模化和传播 GamePlan4Care (GP4C) 是一个新颖的基于网络的培训平台。旨在在可接受且可扩展的在线平台中完全复制 REACH II 的核心组件通过以用户为中心的测试来适应医院环境，包括护理过渡培训， GP4C 在改变 ADRD 护理人员在护理过渡期间的支持方面具有巨大潜力。该提案将把循证护理过渡培训与现有的痴呆症护理人员结合起来支持干预措施以创建新的、独特的干预措施：医院 GP4C 使用计划的适应。方法，我们将在现有的 GP4C 平台的基础上融入量身定制的强有力的支持证据护理过渡培训和支持的目的是：1) 使 GP4C 适应医院护理（医院 GP4C），2) 评估医院 GP4C 干预的可行性和可接受性，以及 3) 评估护理人员医院 GP4C 与健康相比的一项试点随机研究中报告的结果和保留率在目标 1 中，将采用对护理人员和工作人员的半结构化访谈来告知计划。将 GP4C 应用于医院护理，以人为本的设计将用于开发特定的护理过渡。目标 2 中，将收集定量和定性数据以补充现有 GP4C 内容。评估医院 GP4C 的可行性和可接受性，目标 3 是一项单中心试点随机研究。医院 GP4C 相比，将在招募护理人员时进行健康教育控制。该奖项的结果将为 VA 多中心随机对照试验颁发优异奖。医院 GP4C。