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和以人为本的沟通策略，被证明可以减少员工Elderspeak和 BPSD。增加这种有效的基于课堂培训影响的下一步是测试聊天内容 在在线互联网模块中提供。在线提供此培训（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。 这项持续的续签研究将测试一种新的在线版聊天，一种非药理学 有效降低员工Elderspeak沟通并随后减少BPSD的干预措施 患有痴呆症的居民。交互式Chato模块可保持灵活的培训访问权限 员工可以通过互联网访问。在这项务实的试验中，将将120 NHS随机分配给Chato培训 或到对照组。 BPSD和精神药物率数据，从Medicare中心提取 和医疗补助服务疗养院比较和最低数据集，将使用线性混合 造型。 NH用于吸引员工的策略（付费时间完成，认可）和其他支持将是 与员工参与率和结果指标的变化有关的分析。成本将确定 关于结果的变化以及持续使用和加强培训的方法将在 一年的随访调查，针对参与护士的房屋。这项研究的总体目标是为大型准备 扩展这种基于证据的非药理学干预措施的传播和实施 长期护理环境中患有痴呆症的居民的RTC。 这项研究涉及NIA非药物痴呆护理干预措施的里程碑， 症状管理和护理人员支持任务，这是针对阿尔茨海默氏病目标的国家计划 为了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级劳动力 优质的护理技能。减少不适当使用精神活性药物来控制BPSD是当务之急 民族伙伴关系的目标以改善痴呆症护理。作为痴呆症三元人数的人数 接下来的30年，授权护理提供者提供高质量的痴呆症护理至关重要。