The Care Ecosystem Response to COVID-19: Accelerating Research on Dementia Care that Meets the Needs of Caregivers and Persons with Dementia during COVID-19

护理生态系统对 COVID-19 的响应：加速痴呆症护理研究，满足 COVID-19 期间护理人员和痴呆症患者的需求

• 批准号: 10324344
• 负责人: Katherine Laurel Possin
• 金额: $ 290.88万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10324344
• 关键词: Bed Occupancy; Behavior; Behavioral Symptoms; Black race; COVID-19; COVID-19 pandemic; Caregiver Burden; Caregiver support; Caregiver well-being; Caregivers; Caring; Clinical; Communication; Communities; Community Health; Complex; Data; Dementia; Dementia caregivers; Development; Discipline of Nursing; Ecosystem; Effectiveness; Electronic Health Record; Emergency department visit; Emergency medical service; Enrollment; Environment; Evaluation; Family; Family Caregiver; Fee-for-Service Plans; Fright; Future; Geography; Goals; Health Care Reform; Health Personnel; Health system; Healthcare Systems; Home; Hospitalization; Infection; Internet; Intervention; Interview; Latinx; Locales; Medical; Medicare claim; Mental Depression; Methods; Modeling; Monitor; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population Heterogeneity; Primary Health Care; Protocols documentation; Provider; Public Health; Quality of Care; Quality of life; Randomized Clinical Trials; Research; Resources; Risk; Risk Reduction; Rural; Science; Services; Site; Social Work; Specialist; Standardization; Structure; Supervision; Supportive care; Surveys; Technology; Telephone; Time; Training; Underrepresented Populations; Underserved Population; Vulnerable Populations; Work; advanced dementia; advanced disease; barrier to care; base; caregiver depression; cohort; collaborative care; comparison group; cost; dementia care; effectiveness evaluation; effectiveness study; evidence base; experience; family burden; health care model; high risk; hospital readmission; implementation barriers; implementation facilitators; implementation science; implementation strategy; improved; improved outcome; model design; pandemic disease; patient population; person centered; pragmatic trial; primary outcome; programs; racial and ethnic; racial minority population; remote delivery; remote health care; response; satisfaction; secondary outcome; social

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients and caregivers, which have been exacerbated by the COVID- 19 pandemic. The current state of dementia care is inadequate to meet the needs of this growing, vulnerable population. Scalable, effective, and person-centered dementia care models that are aligned with value-based healthcare reforms are needed now. The Care Ecosystem is an accessible, remotely delivered team-based dementia care model, designed to add value for patients, providers and payers in complex organizational and reimbursement structures. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a team of dementia specialists with nursing, social work, and pharmacy expertise. Care Protocols guide proactive, quality care that is documented in the electronic health record. The evidence base to date suggests that the Care Ecosystem improves outcomes important to people with dementia, caregivers, and payers when delivered in a controlled research environment, including reduced emergency department visits, higher quality of life for patients and lower caregiver depression. We propose a rapid pragmatic trial in 6 health systems serving geographically and culturally diverse populations. We will leverage technology, delivering care via the phone and web and using electronic health records to monitor quality improvements and evaluate outcomes while maximizing external validity. In Aim 1, we will use implementation science to identify the model adaptations, facilitators, and barriers to implementing and sustaining the Care Ecosystem during the COVID-19 pandemic. In Aim 2 we will use mixed methods to rigorously evaluate the effectiveness of the Care Ecosystem on outcomes important to patients, caregivers, healthcare providers, and health systems during the pandemic. In Aim 3, we will characterize the patient and caregiver factors associated with treatment benefit. This will include investigating effectiveness in underrepresented groups and elucidating unmet needs that will guide future development work. By simultaneously evaluating the real-world effectiveness and implementation strategies in diverse health systems, this project will bridge the science-practice gap in dementia care during an unprecedented time of heightened strain on family caregivers, healthcare providers and health systems. Furthermore, this work will pave the way for expanding access to high quality dementia care in the future, mitigating the negative impact of dementia on patients and their families across the nation.

项目概要/摘要 痴呆症给患者和护理人员带来沉重负担，而新冠肺炎疫情又加剧了这种负担 19 流行病。目前的痴呆症护理状况不足以满足这个日益增长的弱势​​群体的需求 人口。可扩展、有效且以人为本的痴呆症护理模式，与基于价值的理念相一致 现在需要进行医疗改革。护理生态系统是一个可访问、远程交付、基于团队的系统 痴呆症护理模式，旨在为复杂的组织和支付者中的患者、提供者和付款人增加价值 报销结构。护理由未经许可的护理团队导航员通过电话和网络提供，他们 由具有护理、社会工作和药学专业知识的痴呆症专家团队进行培训和监督。 护理协议指导主动、优质的护理，并记录在电子健康记录中。证据 迄今为止的基础表明，护理生态系统改善了对痴呆症患者很重要的结果， 在受控研究环境中交付时的护理人员和付款人，包括减少紧急情况 科室就诊次数、患者生活质量提高和护理人员抑郁程度降低。我们建议采取快速务实的 在 6 个卫生系统中进行试验，为地理和文化不同的人群提供服务。我们将利用科技， 通过电话和网络提供护理，并使用电子健康记录来监控质量改进和 评估结果，同时最大化外部效度。在目标 1 中，我们将使用实施科学来确定 在此期间实施和维持护理生态系统的模型适应、促进因素和障碍 2019冠状病毒病大流行。在目标 2 中，我们将使用混合方法来严格评估护理的有效性 在此期间对患者、护理人员、医疗保健提供者和卫生系统重要的结果生态系统 大流行。在目标 3 中，我们将描述与治疗益处相关的患者和护理人员因素。 这将包括调查代表性不足群体的有效性并阐明未满足的需求 指导今后的发展工作。通过同时评估现实世界的有效性和实施情况 该项目将在不同卫生系统的战略中弥合痴呆症护理的科学与实践差距 家庭护理人员、医疗保健提供者和卫生系统面临前所未有的压力。 此外，这项工作将为未来扩大获得高质量痴呆症护理的机会铺平道路， 减轻痴呆症对全国患者及其家人的负面影响。