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本地人（AI/AN）人口的增长速度比美国的全股价快3倍人口。到2050年，年龄在65岁以上的AI/ANS的数量将为1,624,000，而数量为1,624,000，而数量为年龄在85岁以上的人将增加7倍至300,000。这些趋势引起了人们对比例增加的关注阿尔茨海默氏病和相关的痴呆症（ADRD）医疗保健和服务。许多AI/ANS通过零散的系统获得医疗保健老年或专业护理，并创造出获得高质量护理的障碍，导致晚期或诊断不足并且对Adrd的护理不足。 AI/AN长老通常会从初级保健医生那里获得医疗保健（PCP）通常缺乏诊断和管理ADRD所需的培训和资源。重点 2016年阿尔茨海默氏病与疾病相关的痴呆症峰会正在通过培训来提高社区的技能痴呆诊断，护理和研究的卫生专业人员。 PCP尤其适合检测轻度认知障碍，通常是未诊断的。虽然研究表明诊所水平的干预措施可以改善ADRD诊断和护理，没有务实的试验专注于为AI/ANS提供服务的设施或PCP。在因此，与为AI/ANS的城市诊所的合作关系，我们设计了“印度人改变阿尔茨海默氏症护理培训”（完整），一种临床水平干预措施，可改善AI/ANS的ADRD诊断和护理质量。完整的主动主部分是筛查，诊断和ADRD护理方面的PCP培训。其他元素包括患者和家庭教育，文化知情的视频以及创建“痴呆症的小册子” 友好的诊所”。首先，我们将在粗糙诊所对PCP进行关键的线人访谈，以适应现有的完整的版本以在粗糙设置中交付。其次，我们将通过14的组随机试验进行完整测试城市和14个农村诊所，使用候补设计为AI/ANS提供初级保健。在诊所一级，我们将依靠电子病历来记录完整的对新ADRD诊断的影响。在PCP级别，我们将测试完整是否增加了自我报告的知识和对痴呆评估的信心，ADRD 护理和护理人员的支持。第三，我们将评估完整的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的护理质量指标在ADRD的AI/ANS的电子病历中记录。我们的具体目的是：1）完整适应用于为AI/ANS服务的粗糙诊所使用； 2）进行GRT以测试完整的对ADRD PCP知识的影响，关心信心和练习行为； 3）评估完整的对临床水平结果的影响（新诊断）和患者水平的护理质量（例如，通常用于ADRD的治疗方法）。快速老年人/人口森林的增长有大量的本地长者，面临着ADRD的风险。这项研究将是临床水平干预措施的少数试验之一，该试验预先培训PCP教育和培训以改进 Adrd Care，也是唯一专为AI/A/A社区设计的护理。