Reducing disability following hospital discharge in vulnerable older adults: the CAPABLE intervention

减少弱势老年人出院后的残疾：CAPABLE 干预措施

基本信息

批准号：
9980253
负责人：
Sarah L Szanton
金额：
$ 62.42万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9980253
关键词：
Activities of Daily Living Acute Address Admission activity Adult African American Age Aging Area Attention Behavioral Caring Clinical effectiveness Data Development Discipline of Nursing Disease Education Effectiveness Effectiveness of Interventions Elderly Environment Equilibrium Ethnic Origin Europe Exercise Pain Management Face Female Floor Funding Gender Goals Grant Health Health Policy Hispanics Home Care Services Home Health Agency Home Nursing Care Home environment Hospitalization Hospitals Housing Impairment Individual Injury Inpatients Institution Intervention Interview Investigation Knowledge Latino Masks Mediation Medicaid Medicare Medicare/Medicaid Mental Depression Modeling Modification New York New York City New Zealand Nurses Nursing Homes Nursing Services Occupational Therapist Occupational Therapy Older Population Operative Surgical Procedures Pain Participant Pathway interactions Performance Persons Pharmaceutical Preparations Physical Function Policies Polypharmacy Population Population Heterogeneity Protocols documentation Public Health Quality of life Randomized Recovery Recovery of Function Rehabilitation therapy Reporting Reproducibility Research Assistant Residual state Risk Risk Factors Safety Science Self-Help Devices Services Skilled Nursing Facilities Social Policies Subgroup Testing Time Training Visit Visiting Nurse Vulnerable Populations aging in place aging population base care costs care providers cost depressive symptoms disability economic impact effectiveness testing eligible participant ethnic diversity evidence base falls follow-up functional decline health care service utilization improved improved functioning innovation intervention cost male modifiable risk novel novel strategies person centered pragmatic trial program costs programs racial diversity recruit repaired treatment as usual treatment group trial design

项目摘要

Two thirds of the 7 million older adults discharged from the hospital annually face new difficulty with activities of daily living (ADLs) that do not resolve by 12 months. To date there has been scant investigation of integrated health and housing interventions to improve physical function. Our proposed trial addresses this scientific gap. It builds upon results from our Center for Medicare and Medicaid Innovation Challenge grant. The older adults hospitalized in the previous year (N=78) who received the CAPABLE intervention, which combines evidence- based nursing, occupational therapy, and handyman components, reported difficulty with 41% fewer ADLs at 5 month follow-up than baseline. An improvement of this magnitude could make the difference between aging at home independently and needing institutional care. The proposed study will target this vulnerable group to provide new reproducible knowledge about improving physical function after skilled care using a rigorous pragmatic trial design. We propose to test the effectiveness of CAPABLE in older adults for whom recovery time and typical treatment were not sufficient to regain their functional ability. These individuals will be at least 60 days post-hospital discharge, have completed the skilled home health care allowed by Medicare, and still have difficulties with ADLs. We will recruit older (≥age 65), principally Latino and African American adults with ≥ 1 ADL difficulties from the Visiting Nurse Service of New York City Medicare Advantage population. We will interview participants at home and randomize them to either treatment (CAPABLE intervention) or control (usual care). Participants in the treatment group will receive up to 10 in-home sessions - ≤6 visits with an occupational therapist and ≤4 visits from a nurse – and ≤$1500 in safety and modification services from a licensed handyman. Each treatment participant will receive each intervention component (education, assessment, identification of functional goals, specific strategies tailored to goals and based on protocols). Participants in the usual care group will not receive grant related attention. All participants will be reassessed at 20 and 52 weeks by a research assistant masked to treatment condition. The primary aims of the study are to: 1) test the effectiveness of CAPABLE in reducing the number of ADLs performed with difficulty at 20 weeks post-randomization; and 2) estimate CAPABLE’s economic impact on subsequent health care utilization and costs over 1 year post-randomization compared to CAPABLE program cost. Our secondary aims include: 1) testing CAPABLE effectiveness on ADL function at 52 weeks; 2) testing effects for key subgroups (gender, ethnicity); and 3) examining theoretically-driven mediation pathways for treatment mechanisms. The proposed study would create new knowledge to improve function following hospitalization. Our approach responds to NIA’s strategic goals to understand disability and to improve the health of diverse older populations. Our approach also has timely policy relevance in promoting aging in place in an aging population.

每年出院的 700 万老年人中，三分之二面临新的活动困难迄今为止，对 12 个月内无法解决的日常生活（ADL）的调查还很少。我们提出的旨在改善身体机能的健康和住房干预措施解决了这一科学差距。它建立在我们的老年人医疗保险和医疗补助创新挑战资助中心的成果之上。去年住院的 (N=78) 接受了 CAPABLE 干预，该干预结合了以下证据：基础护理、职业治疗和勤杂工组成部分的困难，5 岁时 ADL 减少了 41% 与基线相比一个月的随访，这种程度的改善可能会导致衰老之间的差异。拟议的研究将针对这一易受家庭独立和需要机构照顾的群体。使用严格的熟练护理后，提供有关改善身体功能的新的可重复知识我们建议测试 CAPABLE 对康复的老年人的有效性。时间和典型治疗不足以恢复这些人的功能。出院后 60 天，已完成 Medicare 允许的熟练家庭医疗保健，并且仍然我们将招募患有 ADL 困难的老年人（≥ 65 岁），主要是拉丁裔和非裔美国人。纽约市 Medicare Advantage 人群的访视护士服务存在 ≥ 1 项 ADL 困难。在家采访参与者并将他们随机分配到治疗组（有能力干预）或对照组（常规护理）治疗组的参与者将接受最多 10 次家庭治疗 - ≤ 6 次就诊。职业治疗师和 ≤ 4 次护士就诊 - 以及 ≤ 1500 美元的安全和改造服务每位治疗参与者将接受每项干预措施（教育、评估、功能目标的确定、针对目标并基于协议的具体策略）。常规护理组的参与者将不会获得与资助相关的关注。所有参与者都将接受重新评估。研究助理在 20 周和 52 周时对治疗情况进行了匿名研究。 1) 测试 CAPABLE 在减少 20 周时困难的 ADL 次数方面的有效性随机化后；和 2) 估计 CAPABLE 对后续医疗保健利用的经济影响；与 CAPABLE 计划成本相比，随机化后 1 年的成本包括：1) 测试 52 周时 ADL 功能的 CAPABLE 有效性；2) 测试关键亚组（性别、 3）检查治疗机制的理论驱动的中介途径。研究将创造新的知识来改善住院后的功能。 NIA 的战略目标是了解残疾情况并改善不同老年人群的健康。该方法对于促进人口老龄化中的就地老龄化也具有及时的政策相关性。