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

• 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
• 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' s Disease; Alzheimer' 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

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.

项目概要 在美国，九分之一的 65 岁或以上老人患有阿尔茨海默病 (AD) 或与阿尔茨海默病相关的疾病 痴呆症 (ADRD) 患者 (PLWD) 及其护理伙伴依赖初级保健诊所就诊。 痴呆症信息、管理和社区转介是高质量的人际沟通。 与改善健康相关结果相关的三元相互作用模型声称该信息。 交流、融洽关系以及患者和护理合作伙伴参与目标设定和决策是实现目标的关键 然而，有效的人际沟通程度。 三方访问期间所取得的成果尚不清楚，并且很少有干预措施可以使用录音来支持它。 门诊就诊是一种新颖的、基于证据的策略，有可能支持三元相互作用，但其应用 该提案的目的是设计一种增强人际交往的干预措施。 使用访问记录进行三方访问中的沟通 申请人将遵循 NIH 阶段模型来重新设计他们的访问。 访问记录平台 HealthPAL，利用自然语言处理来构建访问信息。 具体目标是： 目标 1（第 0 阶段）：进行前瞻性观察研究，门诊就诊次数为 录制 12 个月的 200 个三元组（PLWD/护理伙伴/临床医生）音频；检查之间的关联 1.b. 三元 AD/ADRD 就诊中的人际沟通和健康相关结果； 三元 AD/ADRD 就诊中人际沟通的推动因素 目标 2（第 1A 阶段）：使 HealthPAL 适应 加强三方 AD/ADRD 访问中的人际沟通；以及 目标 3（阶段 1B）：展示 HealthPAL 在 AD/ADRD 中的可用性、可行性、可接受性和潜在有效性。 1) 人际沟通模型的构建将与健康相关的结果相关联；2) HealthPAL 将超越 In Aim 1 申请人的可用性、可行性和可接受性指标。 将使用解释性顺序混合方法设计，以行为改变轮为目标。 将通过三元时期人际沟通的定量评估来识别行为变化 访问（200 人，每年 3 次；〜600 次访问），辅以有目的的半结构化访谈 1a 三元组样本 (n=42)；在目标 2 中，我们将使用参与式设计方法 (n=60) 重新设计 HealthPAL 使用目标 1 的发现；在目标 3 中，我们将使用开放标签、单臂、多站点试点试验 (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 这项工作是改善 PLWD 的必要的第一步。 通过识别影响人际沟通及其与健康的关系的三元护理 制定的干预措施和收集的大量数据将发挥强大的作用。 可利用该资源来解决与 PLWD 护理相关的临床知识的其他差距。