Indian Transforming Alzheimer's Care Training

印度转变阿尔茨海默病护理培训

基本信息

批准号：
10459241
负责人：
Patrik Lennart Johansson
金额：
$ 34.02万
依托单位：
WASHINGTON STATE UNIVERSITY
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：
2021-08-01 至 2026-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10459241
关键词：
Academy Alaska Native Alzheimer&apos s Disease Alzheimer&apos s disease care Alzheimer&apos s disease related dementia Alzheimer&apos s disease risk American American College of Physicians American Indians Antidepressive Agents Behavior Caregiver support Caring Cholinesterase Inhibitors Chronic Clinic Communities Complex Computerized Medical Record Current Procedural Terminology Codes Data Dementia Diagnosis Education Elderly Electronic Health Record Elements Evaluation Family Fostering Geriatric Assessment Geriatrics Health Health Personnel Health Professional Healthcare Healthcare Systems Impaired cognition Intervention Interview Knowledge Medicare N-Methylaspartate Neuropsychology Outcome Outcome Measure Pamphlets Patient Education Patient Self-Report Patients Pharmaceutical Preparations Population Population Projection Primary Care Physician Primary Health Care Privatization Quality of Care Questionnaires Race Randomized Research Research Project Grants Reservations Resources Rural Services Site Societies System Testing Time Training Training and Education United States Dept. of Health and Human Services United States Indian Health Service Waiting Lists aged antagonist base care outcomes cognitive testing common treatment dementia care design diagnosis quality follow-up health care service health training improved informant innovation medical specialties mild cognitive impairment native elder pragmatic trial programs randomized trial rapid growth rural setting screening skills symposium trend urban Native American

项目摘要

RESEARCH PROJECT 1: ABSTRACT The American Indian and Alaska Native (AI/AN) population is growing 3 times faster than the US all-races population. The number of AI/ANs aged 65+ is expected to triple to 1,624,000 by 2050, while the number of those aged 85+ will increase 7-fold to 300,000. These trends raise concerns about proportionate increases in Alzheimer’s disease and related dementias (ADRD) among AI/AN elders, and concurrent demands for ADRD healthcare and services. Many AI/ANs obtain healthcare through a fragmented system that offers minimal geriatric or specialty care and creates barriers to obtaining high-quality care, resulting in late or under-diagnosis and inadequate care for ADRD. AI/AN elders typically receive their healthcare from primary care physicians (PCPs), who often lack the training and resources needed to diagnose and manage ADRD. The focus of the 2016 Alzheimer’s Disease-Related Dementias Summit was on improving skills in the community by training health professionals in dementia diagnosis, care, and research. PCPs are especially well-placed to detect mild cognitive impairment, which is often undiagnosed. While studies suggest that clinic-level interventions can improve ADRD diagnosis and care, no pragmatic trial has focused on facilities or PCPs that serve AI/ANs. In partnership with an urban clinic serving AI/ANs, we therefore designed “INdians Transforming Alzheimer’s Care Training” (INTACT), a clinic-level intervention to improve ADRD diagnosis and quality of care for AI/ANs. The active principal component of INTACT is PCP training in screening, diagnosis, and care for ADRD. Other elements include patient and family education, culturally informed videos, and brochures to create a “dementia- friendly clinic”. First, we will conduct key informant interviews with PCPs in rural clinics to adapt the existing version of INTACT for delivery in rural settings. Second, we will test INTACT with a group-randomized trial at 14 urban and 14 rural clinics that provide primary care to AI/ANs using a wait-control design. At the clinic level, we will rely on electronic medical records to document INTACT’s effect on new ADRD diagnoses. At the PCP level, we will test whether INTACT increases self-reported knowledge and confidence in dementia assessment, ADRD care, and caregiver support. Third, we will evaluate INTACT’s effect on clinic- and patient-level outcomes. Although we will not collect data directly from patients, we will examine patient-level quality of care metrics documented in electronic medical records for AI/ANs with ADRD. Our Specific Aims are to: 1) Adapt INTACT for use in rural clinics serving AI/ANs; 2) Conduct a GRT to test INTACT’s effects on PCP knowledge of ADRD, care confidence, and practice behavior; and 3) Evaluate INTACT’s effect on clinic-level outcomes (new diagnoses) and patient-level quality of care outcomes (e.g., treatments commonly used for ADRD). The rapid growth of the elderly AI/AN population forecasts a ballooning number of Native elders at risk of ADRD. This study will be one of the few trials of a clinic-level intervention that foregrounds PCP education and training to improve ADRD care, and the only one designed for AI/AN communities.

研究项目 1：摘要美洲印第安人和阿拉斯加原住民 (AI/AN) 人口增长速度是美国所有种族人口的 3 倍到 2050 年，65 岁以上的 AI/AN 人数预计将增加两倍，达到 1,624,000 人，而 85 岁以上的人口将增加 7 倍，达到 30 万。这些趋势引发了人们对人口比例增长的担忧。 AI/AN 老年人中的阿尔茨海默病和相关痴呆症 (ADRD) 以及对 ADRD 的并发需求许多 AI/AN 的医疗保健服务是一个分散的系统，提供的服务很少。老年科或专科护理，为获得高质量护理造成障碍，导致延迟诊断或诊断不足 ADRD 老年人的医疗保健通常来自初级保健医生。（PCP），他们往往缺乏诊断和管理 ADRD 所需的培训和资源。 2016 年阿尔茨海默病相关痴呆症峰会的主题是通过培训提高社区技能从事痴呆症诊断、护理和研究的卫生专业人员尤其适合进行检测。轻度认知障碍，通常未被诊断，而研究表明临床干预可以。改善 ADRD 诊断和护理，但没有任何实用试验重点关注为 AI/AN 提供服务的设施或 PCP。因此，我们与一家为 AI/AN 提供服务的城市诊所合作，设计了“印第安人改变阿尔茨海默病护理 “培训”(INTACT)，一种临床水平的干预措施，旨在改善 AI/AN 的 ADRD 诊断和护理质量。 INTACT 的主要组成部分是针对 ADRD 的筛查、诊断和护理的 PCP 培训。元素包括患者和家庭教育、文化知识视频和小册子，以创建“痴呆症” 首先，我们将对农村诊所的主治医生进行关键信息访谈，以适应现有的情况。其次，我们将在 14 点通过分组随机试验来测试 INTACT。城市和 14 个农村诊所采用等待控制设计为 AI/AN 提供初级保健。将依靠电子病历记录 INTACT 对新 ADRD 诊断的影响。我们将测试 INTACT 是否会增加自我报告的痴呆症评估、ADRD 知识和信心第三，我们将评估 INTACT 对临床和患者水平结果的影响。尽管我们不会直接从患者那里收集数据，但我们将检查患者级别的护理质量指标记录在患有 ADRD 的 AI/AN 的电子病历中。我们的具体目标是： 1) 适应 INTACT。用于为 AI/AN 提供服务的农村诊所；2) 进行 GRT 来测试 INTACT 对 PCP ADRD 知识的影响，护理信心和实践行为；以及 3) 评估 INTACT 对临床水平结果的影响（新）诊断）和患者层面的护理结果质量（例如 ADRD 常用的治疗方法）。老年人 AI/AN 人口的增长预示着患有 ADRD 风险的土著老年人数量将不断增加。将是为数不多的临床干预试验之一，该试验以 PCP 教育和培训为基础，以改善 ADRD 护理，也是唯一为 AI/AN 社区设计的护理。