Improving Care Transitions and Self-care among Informal Caregivers of Hospitalized Older Adults through Digital Tools

通过数字工具改善住院老年人的非正式护理人员的护理过渡和自我护理

基本信息

批准号：
10717633
负责人：
KAREN B HIRSCHMAN
金额：
$ 81.2万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10717633
关键词：
Acute Address African American Behavior Black race COVID-19 Caregiver Burden Caregiver support Caregivers Caring Chronic Chronic Disease Communities Complex Consent Control Groups Data Reporting Discharge Plannings Economics Education Elderly Emergency department visit Enrollment Event Family member Goals Health Health Status Heart failure Home Hospitalization Hospitals Household Human Income Internet Intervention Loneliness Managed Care Measures Medicare Mental Health Modeling Nurses Outcome Participant Patient Care Patient Self-Report Patient-Focused Outcomes Patients Persons Physical Function Population Problem Solving Protocols documentation Race Randomized Randomized, Controlled Trials Readiness Reporting Research Resources Risk Role Sampling Self Care Self Care outcome Self Efficacy Source Strategic Planning Stress Subgroup Technology Testing Time Training Treatment Efficacy Uncompensated Care Videoconferencing Visit Well in self Woman Work acute care arm care episode care recipients caregiver stress caregiving comparative efficacy comparison intervention coping coronavirus disease cost cost estimate digital health digital technology digital tool effectiveness evaluation experience group intervention hospital readmission improved improved outcome informal caregiver informal caregiving innovation interest intervention cost multiple chronic conditions neglect online resource perceived stress physical conditioning pre-pandemic primary outcome racial difference readmission rates response sex skills social social health determinants stress management symposium telephone delivery trial design urgent care virtual virtual health virtual healthcare web site

项目摘要

Informal caregiving is demanding and stressful especially when dealing with a hospitalization. Many caregivers eventually become care recipients themselves as years of stress and deferred self-care put them at increased risk for illness. Self-care refers to the behaviors undertaken to maintain health and manage illness. Engaging in self-care may improve health status (physical functioning and mental well-being). Older adults with multiple chronic conditions (MCCs) often depend on caregivers for assistance, especially after a hospitalization, when caregivers are often expected to follow complicated discharge plans and manage complex skilled care at home. The impact of care gaps and breakdowns saps time for self-care and causes significant stress for caregivers. Health coaching, a support intervention, can improve self-care in patients, but studies evaluating caregivers and racial differences are limited. Less is known about the effect of caregiver support interventions on patient outcomes. Leveraging the growing availability and declining costs of technology and internet access—along with increasing receptivity of virtual care in the wake of COVID-19—we developed and tested a synchronous virtual support intervention, ViCCY (Virtual Caregiver Coach for You), where 10 video conference sessions are delivered by a trained coach over six months that focus on self-care, coping, and stress. In this application, we propose to augment the ViCCY protocol to target caregivers during an acute care episode (during/post- hospitalization) and transitions in care for older adults with MCCs compared to digital health information (DHI) alone (control group). Using a randomized controlled trial (RCT) design, we will enroll informal caregivers with poor self-care (Health Self-Care Neglect scale score ≥2), and block randomize the caregivers 1:1 to the intervention or control group, stratifying randomization by caregiver sex, race, and relationship to the patient. Both groups will receive DHI delivered through a website tailored with care transitions and self-care information, and the intervention group will also receive ViCCY. At baseline, 3-, and 6-months, we will collect self-reported data on self-care, stress, coping, and health status. At 1-month post-hospital discharge the care transitions experience will be collected. At 6-months, we will compare ViCCY to DHI alone to assess intervention efficacy using intent-to-treat analysis. A sample of 250 caregivers (125/arm) will provide >80% power to detect significant differences between the groups on the primary outcome of self-care (Aim 1) and that the magnitude of improvement will be similar in outcomes in Aim 1 between Black/AA and White caregivers (Aim 2). To explore the effect of caregiver outcomes on patients’ outcomes we will examine acute care resource use (rehospitalization, etc.) over a 6-month period (Aim 3). Knowing that not all patients will participate, we will consent a subgroup of the hospitalized older adults cared for by these caregivers (at least 40 dyads). If shown to be efficacious, our virtual health coaching intervention can easily scale to support millions of caregivers worldwide. This application addresses the NIA strategic plan and is in response to NOSI NOT-CA-22-037.

非正式的护理要求和压力很大，尤其是在处理住院时。许多护理人员随着多年的压力和延迟的自我保健使他们自己成为护理的接收者疾病的风险。自我保健是指为维持健康和管理疾病所采取的行为。参与自我保健可以改善健康状况（身体功能和心理健康）。多重的老年人慢性病（MCC）通常依靠照顾者寻求帮助，尤其是在住院后，人们通常会遵循复杂的出院计划并在家管理复杂的熟练护理。护理差距和故障的影响使自我护理的时间减少了时间，并给护理人员带来了巨大的压力。健康教练，一种支持干预，可以改善患者的自我保健，但研究评估护理人员和种族差异是有限的。关于护理人员支持干预措施对患者的影响的知之甚少结果。利用不断增长的可用性和技术和互联网访问的成本下降 - 以及在Covid-19之后，虚拟护理的接受度提高了 - 我们开发并测试了同步虚拟的支持干预措施，Viccy（您的虚拟护理人员教练），其中10次视频会议是由训练有素的教练超过六个月，专注于自我护理，应对和压力。在此应用程序中，我们提议在急性护理发作期间（在/post-post-期间与数字健康信息（DHI）相比单独（对照组）。使用随机对照试验（RCT）设计，我们将与非正式护理人员一起注册自我保健不良（健康自我护理忽略量表得分≥2），并将护理人员1：1随机阻止到干预或对照组，通过护理人员的性别，种族和与患者的关系进行随机化。这两个小组都将通过量身定制的护理过渡和自我保健信息的网站收到DHI，干预小组还将获得牧师。在基线，3个月和6个月时，我们将收集自我报告关于自我护理，压力，应对和健康状况的数据。在院后1个月，护理过渡经验将被收集。在6个月时，我们将比较Viccy与DHI进行比较以评估干预效率使用意图对治疗分析。 250名护理人员（125/ARM）的样本将提供> 80％的功率来检测重要两组之间自我保健的主要结果的差异（AIM 1）和在黑色/AA和白人护理人员之间的AIM 1的结果中，改善将相似（AIM 2）。探索照顾者结果对患者结果的影响我们将检查急性护理资源使用在6个月的时间内（AIM 3）（AIM 3）。知道并非所有患者都会参与，我们将同意这些护理人员（至少40个二元组）照顾住院的老年人的一个亚组。如果显示为了提高效率，我们的虚拟健康教练干预可以轻松扩展以支持数百万的护理人员全世界。该申请解决了NIA战略计划，并响应NOSI NOT-CA-22-037。