Improving Outcomes for Family Caregivers and Older Adults with Complex Conditions: The Adult Day Service Plus Program

改善家庭护理人员和病情复杂的老年人的结果：成人日间服务加计划

基本信息

批准号：
9273347
负责人：
JOSEPH E. GAUGLER
金额：
$ 76.56万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-05-15 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9273347
关键词：
Admission activity Adoption Adult Beds Behavior Behavioral Behavioral Symptoms Caregiver support Caregivers Caring Characteristics Chronic Client Communities Complex Consultations Cost Analysis Costs and Benefits Direct Costs Education Effectiveness Elderly Emotional Enrollment Evaluation Evidence based program Facilities and Administrative Costs Family Family Caregiver Geographic Locations Goals Government Health Healthcare Systems Home environment Impairment Long-Term Care Maintenance Medicare/Medicaid Mental Depression Methodology Methods Modeling Nursing Homes Outcome Participant Pathway interactions Philadelphia Population Practical trial Process Program Effectiveness Program Evaluation Provider Public Health Randomized Reporting Research Personnel Resources Risk Savings Self Care Services Site Stress Supervision Techniques Testing Training Translating Translational Research Translations United States United States National Institutes of Health Vertebral column Work aging population base caregiver depression caregiver interventions community based service complex chronic conditions cost depressive symptoms design evidence base expectation experience improved improved outcome innovation novel programs public health relevance research study response skills symptom management treatment as usual trial design uptake

项目摘要

DESCRIPTION (provided by applicant): Close to 50 million families provide more than 85% of long-term care to older adults with complex chronic conditions. Family caregivers (CGs) typically assume care responsibilities without training or support and may in turn experience multiple health risks themselves including depression. Identifying innovative approaches for reaching this large population and providing evidence-based supportive programs to enhance their well-being is a public health imperative. One approach to reach CGs is to augment existing community-based services with an evidence-based program. Adult day service (ADS) is one such growing and critical community-based option that CGs of older adults with complex conditions rely on. ADS programs offer out-of-home, supervised activities but do not routinely provide evidence-based supportive CG programs. Also ADS use is not consistently associated with reductions in CG depressive symptoms, client behavioral symptoms and nursing home admissions. Thus, ADS is an ideal "test bed" for translating a proven CG intervention to reach and support underserved CGs. We previously developed and evaluated in a small trial, ADS Plus, a program augmenting ADS with systematic support (e.g., education, skill building) to CGs. We showed that ADS Plus in comparison to usual ADS, reduced CG depression and nursing home placement. In response to NIA PA-14- 161 calling for translational research to integrate evidence-based models into existing services, we propose a practical trial design to assess the effectiveness and uptake of ADS Plus on a large scale. We will involve 30 ADS programs throughout the U.S. varying in geographic location and staffing levels and 300 CGs (150 in ADS Plus sites; 150 in ADS usual care sites). We will use cluster and re-randomization techniques, mixed methods, and cost analyses to rigorously evaluate program effectiveness and implementation processes. If effective, and with consultation from a Translation Advisory Board of key ADS leaders, ADS Plus will be disseminated widely. Primary study aims are to: 1) evaluate the effectiveness of ADS Plus to improve CG well-being and reduce depressive symptoms compared to routine ADS use at 6 months (Hypothesis 1: CGs in ADS Plus will report improved well-being and reductions in depressive symptoms compared to those in routine ADS only); and 2) evaluate long-term maintenance effects of ADS Plus at 12 months on CG well-being and depressive symptoms (Hypothesis 2: CGs using ADS Plus will maintain benefits from 6 to 12 months). Additional study aims will: 3) evaluate whether CGs using ADS Plus are more likely to maintain relatives in ADS and less likely to place them in residential settings compared to those in routine ADS over 12 months; 4) estimate ADS Plus costs and assess whether it results in net financial benefits when compared to usual ADS at 6 and 12 months; 5) evaluate the effects of ADS Plus on client behaviors and CG efficacy and upset managing symptoms; and 6) evaluate theoretically-derived (RE-AIM, Stress Process Model) mediational pathways of treatment change including CG acceptance and staff adoption of ADS Plus over 12 months.

描述（由申请人提供）：近 5000 万个家庭为患有复杂慢性病的老年人提供超过 85% 的长期护理，家庭护理人员 (CG) 通常在没有培训或支持的情况下承担护理责任，因此可能会出现多种健康状况。确定创新方法来覆盖这一庞大人群并提供基于证据的支持计划以提高他们的福祉是一项公共卫生当务之急，以证据为基础来增强现有的基于社区的服务。程序。成人日间服务 (ADS) 是一种日益增长且重要的基于社区的选择，患有复杂情况的老年人的 CG 依赖于 ADS 计划提供户外、有人监督的活动，但通常不提供基于证据的支持性 CG 计划。此外，ADS 的使用并不总是与 CG 抑郁症状、客户行为症状和疗养院入院的减少相关，因此，ADS 是一个理想的“试验台”，用于将经过验证的 CG 干预措施转化为覆盖和支持我们之前开发和评估的 CG。在一项小型试验 ADS Plus 中，该计划通过对 CG 的系统支持（例如教育、技能培养）来增强 ADS，我们表明，与普通 ADS 相比，ADS Plus 可以减少 CG 抑郁和疗养院安置。 -14- 161 呼吁转化研究将基于证据的模型整合到现有服务中，我们提出了一个实用的试验设计来大规模评估 ADS Plus 的有效性和采用情况。我们将在整个过程中涉及 30 个 ADS 项目。美国的地理位置和人员配置水平各不相同，有 300 个 CG（ADS Plus 站点有 150 个；ADS 常规护理站点有 150 个）。我们将使用聚类和重新随机化技术、混合方法和成本分析来严格评估计划有效性和实施流程。如果有效，并与 ADS 主要领导者的翻译顾问委员会协商，ADS Plus 将得到广泛传播。主要研究目标是： 1) 评估 ADS Plus 的有效性以改进。 6 个月时与常规 ADS 使用相比，CG 健康状况良好并减少抑郁症状（假设 1：与仅使用常规 ADS 相比，ADS Plus 中的 CG 将报告改善健康状况并减少抑郁症状）； ADS Plus 在 12 个月时对 CG 健康和抑郁症状的长期维持效果（假设 2：使用 ADS Plus 的 CG 将维持 6 至 12 个月的益处）其他研究目标将： 3) 评估 12 个月内，与常规 ADS 相比，使用 ADS Plus 的 CG 是否更有可能将亲属留在 ADS 中，并且不太可能将其安置在住宅环境中； 4) 估计 ADS Plus 的成本和评估 6 个月和 12 个月时与普通 ADS 相比是否会产生净财务收益；5) 评估 ADS Plus 对客户行为和 CG 功效以及管理心烦意乱症状的影响；6) 评估理论上得出的结果；（RE-AIM，压力过程模型）治疗改变的中介途径，包括 CG 接受度和员工在 12 个月内采用 ADS Plus。