Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce

评估以人为本的国家培训计划，以加强痴呆症护理人员队伍

• 批准号: 10525110
• 负责人: Sheryl Zimmerman
• 金额: $ 78.47万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525110
• 关键词: Adoption; Age-Years; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Assisted Living Facilities; Attitude; Beds; Behavior; Caring; Case Mixes; Certification; Characteristics; Cluster randomized trial; Communities; Community Healthcare; Competence; Computers; Country; Data; Dementia; Development; Discipline of Nursing; Education; Educational process of instructing; Effectiveness; Family; Family member; Feeling; Floods; Hour; Impaired cognition; Individual; Injury; Intention; Knowledge; Learning; Long-Term Care; Minority; Modeling; National Institute on Aging; Occupations; Outcome; Perception; Personal Satisfaction; Persons; Preparation; Procedures; Provider; Psychological reinforcement; Quality of life; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Reaction; Reporting; Residential Treatment; Self Care; Severities; Tablet Computer; Testing; Time; Training; Training Programs; Waiting Lists; Workplace; arm; base; behavior change; burnout; care outcomes; care providers; community living; cost; dementia care; effectiveness evaluation; effectiveness implementation study; evidence base; expectation; experience; handheld mobile device; high school; improved; improved outcome; interest; learned behavior; peer support; person centered; programs; recruit; residential care facility; response; skills; skills training; virtual

Project Summary/Abstract More than 75% of persons living with Alzheimer's disease and related dementias who reach 80 years of age require residential long-term care, which is increasingly provided in assisted living (AL). Across the country, almost 29,000 AL communities with more than 996,000 beds have become the primary residential care provider for persons with dementia: 90% of AL residents have cognitive impairment and 42% have recorded moderate or severe dementia, with actual rates being higher. AL provides supportive but not nursing services; consequently, virtually all care is provided by direct care workers (nursing assistants and personal care aides). Unfortunately, direct care workers are undervalued and undertrained, leading to poor care, workplace injury, dissatisfaction, and high turnover. AL is state-regulated, and only 17 states stipulate minimum training hours (some being as low as one hour), meaning that two-thirds of states are silent on training. Fewer than 40% of staff have education beyond high school, and so it is not surprising that a minority report sufficient knowledge to care for persons with dementia. In striving to fill this gap, training for direct care workers must be accessible and have efficacy in benefitting the staff, organization, and persons with dementia. Online training is an especially promising option due to its low cost, wide availability, and potential for self- pacing, automated skills tests, and certification. The Alzheimer's Association is the national leader in dementia care training, and in 2021 developed essentiALZTM (pronounced “essentials”), an online program teaching evidence-based, person-centered care, which can be accessed from a computer, tablet, or mobile device. Already more than 1,500 staff have essentiALZ certification, but as is true of the majority of training programs, evidence as to its ability to improve care and outcomes is lacking. It is possible that essentiALZ is effective in changing care and outcomes, but it may also be that additional supports are necessary to do so. A timely model of support is Project ECHO, which has flooded the field of long-term care as a proven way to provide expert guidance and peer support via a remote, online approach. Adding ECHO to online dementia training might provide a necessary boost to achieve care change and improved outcomes. The proposed project responds to the NIA Notice of Special Interest that calls for strengthening the workforce through enhancing and supporting skills training. It will conduct a hybrid implementation/effectiveness cluster- randomized trial in 126 AL communities across six states, comparing essentiALZ alone, essentiALZ + ECHO enhancement, and a waitlist control. Outcomes grounded in the RE-AIM model and the Kirkpatrick training effectiveness model will be examined over six months, comparing the arms in terms of (1) implementation and (2) effectiveness, and (3) examining the extent to which implementation and effectiveness differ based on characteristics of the AL community, staff, residents, and family members. Results will inform next steps in dementia care training for the AL and broader long-term care workforce.

项目摘要/摘要 超过75％的阿尔茨海默氏病和相关痴呆症患者达到80岁 要求居民长期护理，这越来越多地用于辅助生活（AL）。全国各地 近29,000个AL社区拥有996,000张床，已成为主要居民护理 痴呆症患者的提供者：90％的AL居民患有认知障碍，有42％的居民已记录 中度或重度痴呆症，实际率更高。 AL提供支持但不提供护士服务； 因此，几乎所有的护理都是由直接护理人员（护理助理和个人护理助手）提供的。 不幸的是，直接护理人员被低估和训练不足，导致护理不良，工作场所受伤， 不满意和更高的营业额。 AL受国家监管，只有17个州固定最低培训时间 （有些人低至一小时），这意味着三分之二的州对培训保持沉默。少于40％ 员工在高中以外的教育，因此少数族裔报告足够的知识也就不足为奇了。 照顾痴呆症患者。在努力填补这一空白时，必须可以访问直接护理人员的培训 并有效率使员工，组织和痴呆症患者受益。 在线培训是一个特别有希望的选择，因为其成本较低，可用性和自我的潜力 起搏，自动化技能测试和认证。阿尔茨海默氏症协会是痴呆症的国家领导人 护理培训，2021年开发了必需的ALZTM（发音为“ Essentials”），这是一个在线计划教学 以循证为中心的护理，可以从计算机，平板电脑或移动设备访问。 已经有1,500多名员工拥有必不可少的ALZ认证，但是与大多数培训计划一样， 缺乏有关其改善护理和结果的能力的证据。基本ALZ可能有效 改变护理和结果，但也可能需要其他支持。及时 支持模型是Echo项目，它淹没了长期护理领域，作为一种验证的方式 专家指导和通过远程，在线方法的支持。将回声添加到在线学位培训中 可能会提供必要的推动力，以实现护理变化和改善结果。 拟议的项目回应了NIA的特殊兴趣通知，该通知要求加强劳动力 通过增强和支持技能培训。它将进行混合实施/有效性集群 - 在六个州的126个AL社区中的随机试验，仅比较基本的ALZ，Essential ALZ + Echo 增强和候补控制。基于Re-Aim模型和Kirkpatrick培训的结果 有效性模型将在六个月内检查，并根据（1）实施和 （2）有效性，以及（3）根据基于多大不同 AL社区，员工，居民和家庭成员的特征。结果将告知下一步 痴呆症护理培训和更广泛的长期护理人员。