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.

抽象的痴呆症患者人数不断增加，对提供高质量护理提出了挑战家庭（NH）护理因痴呆症（BPSD）的行为和心理社会症状而变得复杂，例如痴呆症患者失去理智时会出现攻击性行为、大声喊叫、走神和退缩和沟通能力，无法口头表达 NH 员工未满足的身体和心理需求。使用“长辈语”，这种类似于儿语的语言对居民有侮辱性的影响。 BPSD 导致更多地使用精神药物来控制 BPSD、更高的人员需求、更多员工压力和流动率以及增加的成本改变谈话 (CHAT) 培训计划对员工进行教育。关于长辈言论和更好的沟通策略，并被证明可以减少员工的长辈言论和 BPSD NH 居民为了提高这种有效的课堂培训的影响，下一步是测试 CHAT。在线互联网模块中提供的内容可以改善忙碌员工的访问。以及农村和小型国家卫生机构的宣传，以加强在护理机构中的传播，以改善痴呆症护理。这项 R61/R33 研究将针对 PAR-18-585 开发并进行一项实用的临床试验，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。在 R61 规划阶段，对 120 个 NH 进行住院 BPSD 和精神药物使用的 CHATO 培训。我们将与 NH 工作人员一起对在线模块进行试点，以建立 R33 试验开发的 NH 站点；临床试验方案、操作手册和数据表格；制定数据管理、共享和保真度；保证协议；并获得 IRB 批准。NH 管理人员和工作人员小组将为团队提供建议。招募策略和自然处理长者语言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个NH中进行务实试验，这些NH将被随机分配给CHATO 训练或对照组 BPSD 和精神药物用药率数据，从中心提取。医疗保险和医疗补助服务疗养院比较和最小数据集，将使用用于让员工参与 CHATO 的线性混合模型（带薪休假、认可）和成本将识别使用自然语言处理为员工提供即时信息的自我监控应用程序的效果。这项研究将测试 NIA 的里程碑。非药物痴呆症护理干预措施，解决阿尔茨海默病国家计划的目标是提高护理质量和效率，阿尔茨海默病协会计划建设一支高素质的劳动力队伍护理技能的目标是减少精神活性药物的不当使用，以控制 BPSD。非药物方法符合改善痴呆症国家伙伴关系的首要目标护理。未来 30 年，诊断出痴呆症的人数将增加两倍，需要加强护理。为痴呆症患者提供高质量护理的医疗服务提供者至关重要。