Changing Talk Online Training (CHATO): A National Trial to Reduce Behavioral Symptoms in Long Term Care Residents with Alzheimer's Disease and Other Dementias

改变谈话在线培训 (CHATO)：一项旨在减少患有阿尔茨海默病和其他痴呆症的长期护理居民行为症状的全国试验

• 批准号: 10056313
• 负责人: KRISTINE N. WILLIAMS
• 金额: $ 77.04万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10056313
• 关键词: Address; Administrator; Adoption; Adult; Age; Aggressive behavior; Alzheimer' s Disease; Antipsychotic Agents; Bathing; Behavior; Behavior Control; Behavioral; Behavioral Symptoms; Caregiver support; Caring; Characteristics; Clinical Trials; Code; Cognitive; Communication; Control Groups; Data; Data Set; Dementia; Dependence; Diagnosis; Education; Evaluation; Evidence based intervention; Evidence based practice; Exhibits; Focus Groups; Goals; Home Nursing Care; Honey; Improve Access; Incentives; Individual; Injury; Internet; Intervention; Interview; Knowledge; Long-Term Care; Maintenance; Measures; Methods; Mission; Modeling; Motivation; Names; Nursing Homes; Outcome; Outcome Measure; Persons; Pharmaceutical Preparations; Population; Process; Psychological reinforcement; Quality of Care; Quality of life; Randomized; Reporting; Research; Research Personnel; Rural; Speech; Stress; Surveys; Symptoms; Testing; Time; Training; Training Activity; Training Programs; Translating; Translations; United States Centers for Medicare and Medicaid Services; Withdrawal; base; care providers; cost; cost effectiveness; dementia care; empowered; evidence base; flexibility; follow-up; implementation strategy; improved; innovation; person centered; pragmatic trial; primary outcome; programs; psychological symptom; psychosocial; rate of change; rurality; side effect; skills; skills training; symptom management

Project 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 person-centered communication strategies and is proven to reduce staff elderspeak and BPSD. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. Providing this 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 continuing renewal study will test a new, online version of CHAT, a nonpharmacological intervention that effectively decreases staff elderspeak communication and subsequently reduces BPSD in NH residents with dementia. The interactive CHATO modules provide flexible access to training, continuously accessible to staff via the internet. In this pragmatic trial, 120 NHs 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 (paid time to complete, recognition) and other supports will be analyzed in relation to staff participation rates and changes in the outcome measures. Costs will be determined in relation to changes in the outcomes and ongoing use and reinforcement of training will be assessed at a one-year follow-up survey for participating nursing homes. The overall goal of this study is to prepare for large scale dissemination and implementation of this evidence-based nonpharmacological intervention to reduce RTC for residents with dementia across long term care settings. This research addresses NIA's milestones for nonpharmacological dementia care interventions, NINR's symptom management and caregiver support missions, 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. Reducing inappropriate use of psychoactive medications to control BPSD is the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons with dementia triples in the next 30 years, empowering care providers to provide high quality dementia care is of critical importance.

项目摘要 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。 关于长辈言论和以人为本的沟通策略，并被证明可以减少员工的长辈言论和 BPSD 提高这种有效的课堂培训影响力的下一步是测试 CHAT 内容。 通过在线互联网模块提供此培训 (CHATO) 可以改善忙碌员工的访问情况。 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。 这项持续的更新研究将测试 CHAT 的新在线版本，这是一种非药理学药物 有效减少新罕布什尔州员工长老语沟通并随后减少 BPSD 的干预措施 交互式 CHATO 模块为患有痴呆症的居民提供灵活的持续培训。 在这项务实的试验中，120 名 NH 员工将被随机分配参加 CHATO 培训。 或从医疗保险中心提取的对照组 BPSD 和精神药物用药率数据。 和医疗补助服务疗养院比较和最小数据集，将使用线性混合进行比较 用于吸引员工参与的 NH 策略（付费完成、认可）和其他支持将被采用。 将根据工作人员参与率和结果衡量标准的变化进行分析。 与结果的变化以及培训的持续使用和强化有关的评估将在 对参与的疗养院进行为期一年的跟踪调查，这项研究的总体目标是为大型疗养院做好准备。 大规模传播和实施这种基于证据的非药物干预措施，以减少 针对长期护理机构中患有痴呆症的居民的 RTC。 这项研究涉及 NIA 在非药物痴呆护理干预方面的里程碑，NINR 症状管理和护理人员支持任务，国家解决阿尔茨海默氏病计划的目标 提高护理质量和效率，阿尔茨海默病协会计划建立一支具有高水平的劳动力队伍 减少不恰当使用活性药物来控制 BPSD 是首要任务。 随着痴呆症患者数量增加两倍，改善痴呆症护理国家伙伴关系的目标。 未来 30 年，赋予护理提供者提供高质量痴呆症护理的能力至关重要。