The Care Ecosystem Response to COVID-19: Accelerating Research on Dementia Care that Meets the Needs of Caregivers and Persons with Dementia during COVID-19

护理生态系统对 COVID-19 的响应：加速痴呆症护理研究，满足 COVID-19 期间护理人员和痴呆症患者的需求

• 批准号: 10634511
• 负责人: Katherine Laurel Possin
• 金额: $ 296.74万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634511
• 关键词: Acceleration; Bed Occupancy; Behavior; Behavioral Symptoms; Black race; COVID-19; COVID-19 pandemic; Caregiver Burden; Caregiver support; Caregiver well-being; Caregivers; Caring; Clinical; Communication; Communities; Community Health; Complex; Data; Dementia; Dementia caregivers; Development; Discipline of Nursing; Ecosystem; Effectiveness; Electronic Health Record; Emergency department visit; Emergency medical service; Enrollment; Environment; Evaluation; Family; Family Caregiver; Fee-for-Service Plans; Fright; Future; Geography; Goals; Health Personnel; Health system; Healthcare; Healthcare Systems; Home; Hospitalization; Infection; Internet; Intervention; Interview; Latinx; Licensing; Locales; Medical; Medicare claim; Mental Depression; Methods; Modeling; Monitor; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population Heterogeneity; Primary Care; Protocols documentation; Provider; Public Health; Quality of Care; Quality of life; Research; Resources; Risk; Risk Adjustment; Rural; Sampling; Science; Services; Site; Social Work; Social isolation; Specialist; Structure; Supportive care; Surveys; Technology; Telephone; Time; Training; Underrepresented Populations; Underserved Population; Vulnerable Populations; Work; advanced dementia; advanced disease; barrier to care; caregiver depression; cohort; collaborative care; comparison group; cost; dementia care; design; effectiveness evaluation; effectiveness study; ethnic minority population; evidence base; experience; family burden; health care model; high risk; hospital readmission; implementation barriers; implementation facilitators; implementation science; implementation strategy; implementation/effectiveness; improved; improved outcome; pandemic disease; patient population; person centered; pragmatic trial; primary outcome; programs; racial minority population; randomized, clinical trials; remote delivery; remote health care; response; satisfaction; secondary outcome; standardized care

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients and caregivers, which have been exacerbated by the COVID- 19 pandemic. The current state of dementia care is inadequate to meet the needs of this growing, vulnerable population. Scalable, effective, and person-centered dementia care models that are aligned with value-based healthcare reforms are needed now. The Care Ecosystem is an accessible, remotely delivered team-based dementia care model, designed to add value for patients, providers and payers in complex organizational and reimbursement structures. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a team of dementia specialists with nursing, social work, and pharmacy expertise. Care Protocols guide proactive, quality care that is documented in the electronic health record. The evidence base to date suggests that the Care Ecosystem improves outcomes important to people with dementia, caregivers, and payers when delivered in a controlled research environment, including reduced emergency department visits, higher quality of life for patients and lower caregiver depression. We propose a rapid pragmatic trial in 6 health systems serving geographically and culturally diverse populations. We will leverage technology, delivering care via the phone and web and using electronic health records to monitor quality improvements and evaluate outcomes while maximizing external validity. In Aim 1, we will use implementation science to identify the model adaptations, facilitators, and barriers to implementing and sustaining the Care Ecosystem during the COVID-19 pandemic. In Aim 2 we will use mixed methods to rigorously evaluate the effectiveness of the Care Ecosystem on outcomes important to patients, caregivers, healthcare providers, and health systems during the pandemic. In Aim 3, we will characterize the patient and caregiver factors associated with treatment benefit. This will include investigating effectiveness in underrepresented groups and elucidating unmet needs that will guide future development work. By simultaneously evaluating the real-world effectiveness and implementation strategies in diverse health systems, this project will bridge the science-practice gap in dementia care during an unprecedented time of heightened strain on family caregivers, healthcare providers and health systems. Furthermore, this work will pave the way for expanding access to high quality dementia care in the future, mitigating the negative impact of dementia on patients and their families across the nation.

项目摘要/摘要 痴呆症给患者和看护人造成了巨大的负担，这已受到COVID的加剧 19大流行。痴呆症护理的当前状态不足以满足这一增长，脆弱的需求 人口。可扩展，有效且以人为本的痴呆症护理模型与基于价值的 现在需要进行医疗改革。护理生态系统是一个可访问的，遥远的基于团队的 痴呆症护理模型，旨在为复杂的组织和付款人增加价值 报销结构。无执照的护理团队导航员通过电话和网络提供护理，他 由痴呆症专家团队培训和监督护理，社会工作和药房专业知识。 护理方案指导电子健康记录中记录的主动，优质护理。证据 迄今为止的基础表明，护理生态系统改善对痴呆症患者重要的结果， 护理人员和付款人在受控的研究环境中交付时，包括紧急情况减少 部门访问，患者的较高生活质量和较低的护理人员抑郁症。我们提出了一个快速务实的 在6个卫生系统中的试验，在地理和文化上多样化的人群中。我们将利用技术， 通过电话和网络提供护理，并使用电子健康记录来监控质量改进和 评估结果，同时最大化外部有效性。在AIM 1中，我们将使用实施科学来识别 模型的改编，促进者和实施和维持护理生态系统的障碍 2019冠状病毒病大流行。在AIM 2中，我们将使用混合方法严格评估护理的有效性 关于对患者，护理人员，医疗保健提供者和卫生系统至关重要的结果的生态系统 大流行。在AIM 3中，我们将表征与治疗益处相关的患者和护理人员因素。 这将包括调查代表性不足的群体的有效性，并阐明未满足的需求 指导未来的发展工作。通过同时评估现实世界的有效性和实施 该项目在各种卫生系统中的策略将弥合痴呆症护理中的科学效果差距 空前的家庭护理人员，医疗保健提供者和卫生系统的压力增加。 此外，这项工作将为扩大未来获得高质量痴呆护理的访问铺平道路 减轻痴呆症对全国患者及其家人的负面影响。