Changing Talk Online (CHATO): A Pragmatic Trial to Reduce Behavioral Symptoms in Dementia Care

在线改变谈话（CHATO）：减少痴呆症护理中行为症状的务实试验

基本信息

批准号：
9788216
负责人：
KRISTINE N. WILLIAMS
金额：
$ 13.62万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-30 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9788216
关键词：
Address Administrator Adult Aggressive behavior Alzheimer&apos s Disease Antipsychotic Agents Bathing Behavior Behavior Control Behavior Therapy Behavioral Behavioral Symptoms Caring Clinical Clinical trial protocol document Code Cognitive Communication Control Groups Data Data Collection Data Set Dementia Dependence Diagnosis Education Enrollment Evidence based practice Exhibits Feedback Goals Home Nursing Care Honey Improve Access Incentives Individual Injury Institutional Review Boards Internet Intervention Manuals Measures Modeling Monitor Motivation Natural Language Processing Nursing Homes Persons Pharmaceutical Preparations Phase Population Pragmatic clinical trial Preparation Protocols documentation Psycholinguistics Quality of Care Quality of life Randomized Research Research Personnel Rural Services Site Speech Stress Symptoms Testing Time Training Training Programs Training Support Translations United States Centers for Medicare and Medicaid Services Withdrawal base care providers cost data management dementia care design empowered evidence base improved innovation operation performance site post intervention pragmatic trial programs psychological symptom psychosocial recruit response side effect skills tool

项目摘要

ABSTRACT The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use “elderspeak,” speech similar to baby talk that is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and better communication strategies and is proven to reduce staff elderspeak and BPSD in NH residents. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. CHAT training Online (CHATO) can improve access for busy staff and those in rural and small NHs to increase dissemination across care settings to improve dementia care. This R61/R33 study will develop and conduct a pragmatic clinical trial in response to PAR-18-585, Pragmatic Trials for Dementia Care I Long-term Services and Support (LTSS) Settings. We will test the effects of CHATO training on resident BPSD and psychotropic medication use in 120 NHs. In the R61 planning phase we will pilot test the online modules with NH staff to establish effects; recruit NH sites for the R33 trial; develop the clinical trial protocol, manual of operations, and data forms; develop data management, sharing, and fidelity assurance protocols; and obtain IRB approvals. A panel of NH administrators and staff will advise the team on recruitment strategies and a natural processing elderspeak feedback app will be tested in the clinical setting. In R33 phase we will conduct the pragmatic trial in 120 NHs that will be randomly assigned to CHATO training or to the control group. BPSD and psychotropic medication rate data, extracted from the Center for Medicare and Medicaid Services Nursing Home Compare and Minimum Data Set, will be compared using linear mixed modeling. NH strategies used to engage staff in CHATO (paid time off, recognition) and costs will be identified. The effects of a self-monitoring app that uses natural language processing to give staff immediate feedback on their elderspeak use will be tested. This research addresses NIA's milestones for nonpharmacological dementia care interventions, the National Plan to Address Alzheimer's Disease goal to enhance care quality and efficiency, and the Alzheimer's Association Plan to build a workforce with high-quality care skills. The goal of reducing inappropriate use of psychoactive medications to control BPSD using this nonpharmacological approach aligns with the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons diagnosed with dementia triples in the next 30 years, empowering care providers to provide high quality care for individuals with dementia is of critical importance.

抽象的痴呆症患者不断增长为提供高质量护士的挑战家（NH）护理。痴呆症（BPSD）的行为和社会心理症状使护理变得复杂当患有痴呆症患者失去认知的人时，激进的声音爆发，徘徊和退出和沟通能力，不能口头表达未满足的身体和社会心理需求。 NH员工使用“ Elderspeak”，类似于贬低居民的婴儿谈话。居民对Elderspeak的反应 BPSD导致使用精神药物来控制BPSD，更高的人员需求，更多员工的压力和营业额，增加了成本。不断变化的谈话（聊天）培训计划教育员工关于Elderspeak和更好的沟通策略，被证明可以减少员工Elderspeak和BPSD NH居民。增加这种有效的课堂培训影响的下一步是测试聊天在线互联网模块中提供的内容。在线聊天培训（Chato）可以改善忙碌的员工的访问权限那些在粗糙和小的NHS中以增加护理环境的传播以改善痴呆症护理。这项R61/R33研究将针对PAR-18-585制定并进行务实的临床试验，痴呆症护理I长期服务和支持（LTSS）设置的务实试验。我们将测试效果对居民BPSD的Chato培训和120 NHS中的精神药物使用。在R61计划阶段我们将与NH员工一起测试在线模块以建立效果；招募NH站点进行R33试验；发展临床试验方案，操作手册和数据表格；开发数据管理，共享和忠诚保证协议；并获得IRB批准。 NH管理员和工作人员小组将为团队提供建议招聘策略和自然处理Elderspeak反馈应用程序将在临床环境中进行测试。在R33阶段，我们将在120 NHS中进行务实的试验，该试验将随机分配给Chato 培训或对照组。 BPSD和精神药物率数据，从中心提取 Medicare和Medicaid服务疗养院比较和最低数据集将使用线性混合建模。 NH策略用于吸引员工参与Chato（带薪休假，认可）和费用被识别。使用自然语言处理的自我监控应用程序的影响将测试有关其Elderspeak使用的反馈。这项研究解决了NIA的里程碑非药物痴呆症护理干预措施是针对阿尔茨海默氏病目标的国家计划提高护理质量和效率，以及阿尔茨海默氏症协会计划建立高质量的劳动力护理技能。减少不适当使用精神活性药物来控制BPSD的目的非药理学方法与民族伙伴关系的首要目标保持一致，以改善痴呆症关心。由于未来30年被诊断出患有痴呆症的人数，赋予护理能力为患有痴呆症患者提供高质量护理的提供者至关重要。