Building Resilience In SKilled nursing facilities (BRISK): Development and Pilot Testing of a Dyadic Intervention for Psychological Distress in Post-Acute Skilled Nursing Care

建立熟练护理设施的复原力（BRISK）：针对急性后熟练护理中心理困扰的二元干预措施的开发和试点测试

• 批准号: 10739279
• 负责人: Evan Plys
• 金额: $ 19.4万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 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/10739279
• 关键词: Acute; Address; Adherence; Adoption; Anxiety; Area; Award; Care given by nurses; Caregivers; Caring; Chronic; Client satisfaction; Clinical; Clinical Trials; Communities; Conduct Clinical Trials; Coping Skills; Data; Development; Disparity; Dissemination and Implementation; Distress; Educational Status; Effectiveness; Elderly; Ensure; Environment; Equity; Evidence based intervention; Expectancy; Family; Feedback; Focus Groups; Foundations; Future; General Hospitals; Goals; Health; Health care facility; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hybrids; Individual; Intervention; Interview; Knowledge; Leadership; Long-Term Care; Massachusetts; Measures; Medical; Medicare/Medicaid; Mental Depression; Mentorship; Methods; Mission; Modeling; Modification; Nursing Homes; Outcome; Outcome Measure; Participant; Patient Care; Patients; Persons; Pilot Projects; Population; Program Evaluation; Protocols documentation; Psychological Stress; Questionnaires; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Design; Research Personnel; Research Support; Resources; Risk; Risk Reduction; Skilled Nursing Facilities; Statistical Data Interpretation; Stress; Structure; Surveys; System; Testing; Training; United States National Institutes of Health; Work; acceptability and feasibility; acute care; arm; beneficiary; care preference; career; coping; design; dual eligible; effectiveness trial; efficacy testing; experience; family management; feasibility testing; health disparity; health equity promotion; hospital readmission; improved; intergenerational; intervention refinement; medical schools; member; multidisciplinary; multiple chronic conditions; novel; nursing skill; older patient; patient oriented; pilot test; promote resilience; psychologic; psychological distress; psychological outcomes; psychological symptom; psychosocial; readmission rates; skill acquisition; skills; socioeconomic disadvantage; socioeconomics; stressor; telehealth; theories; therapy design; therapy development; treatment as usual

Background: The timing of a skilled nursing facility (SNF) stay is met with significant psychological stress for both patients and family care-partners (CPs), which can negatively impact recovery as well as long-term health and psychological outcomes. These consequences may be magnified among socioeconomically disadvantaged patients (i.e., dual-eligible beneficiaries) and their CPs, who experience multiple health disparities. Dyadic psychological interventions promote coping skills to improve short-term distress and reduce the risk of chronic psychological symptoms for both patients and CPs, but are untested in SNFs. To address this limitation and to progress the field toward improving psychological care in SNFs, I will develop and pilot “Building Resilience In SKilled nursing facilities” (BRISK), a dyadic intervention designed to reduce psychological distress among socioeconomically disadvantaged patients and CPs during a post-acute SNF stay. Specific aims and research design: (1) iteratively develop BRISK with multi-level stakeholder input by conducting semi-structured interviews with up to 20 patient-CP dyads and 4 focus groups with SNF clinical and leadership staff (NIH Model Stage 1a); (2) refine and optimize BRISK by conducting a single-arm open pilot study with 5 patient-CP dyads and exit interviews with 5 SNF staff (NIH Model Stage 1a); and (3) test the feasibility, acceptability, and fidelity of BRISK by conducting a pilot cluster randomized controlled trial with patient-CP dyads completing BRISK (N=30 dyads) or minimally enhanced usual care (N=20 dyads) in 3 SNFs (NIH Stage Model 1b). A diverse stakeholder advisory council will convene throughout the award period to collaboratively guide intervention development and refinements to enhance the relevance and real-world adoption potential of BRISK. Training: I have developed a rigorous training plan designed to support the research aims and end goal of this proposal, as well as help me launch my career as an independent patient-oriented investigator with the long-term career goal of improving psychological care for socioeconomically disadvantaged patients and families in SNFs. The specific training goals are to: (1) develop skills in intervention development and optimization; (2) acquire skills for clinical trials research, including statistical analysis, with dyads in SNFs; and (3) acquire skills for research with socioeconomically disadvantaged older adults and families, with the goal of promoting health equity. The research environments at Massachusetts General Hospital and Harvard Medical as well as my multidisciplinary mentorship team with distinct and complementary areas of expertise will help ensure the successful achievement of training goals. Impact: I am a clinical geropsychologist with expertise in residential post-acute and long-term care settings. My ultimate mission is to develop a feasible, scalable, and sustainable psychological intervention that improve care among dual-eligible patients and their CPs receiving post-acute SNF care. The research and training goals outlined in this K23 proposal will provide the foundation for future clinical trials to test the efficacy-effectiveness and, eventually, dissemination and implementation of BRISK with socioeconomically disadvantaged patient-CP dyads receiving post-acute care in SNFs, a high-need and under- studied population. This work is well aligned with NIA's goal of improving coping ability and reducing caregiver, family, and patient stress (Strategic Goal C; Objective C-4) with a NIA priority population.

背景：熟练的护士设施（SNF）的时机对两名患者都有重大的心理压力 和家庭护理人员（CPS），可能对康复以及长期健康和心理影响产生负面影响 结果。这些后果可能会在受社会经济受到干扰的患者中放大（即符合双重资格 受益人）及其CPS，他们经历了多种健康差异。二元心理干预促进应对 改善短期困扰并减少患者和CPS慢性心理症状的风险的技能，但 在SNF中未经测试。为了解决这一局限性并在改善SNF中的心理护理方面发展领域，我 将开发和试行“在熟练护理设施中建立弹性”（Brisk），这是一种旨在减少的二元干预措施 急性后SNF住院期间，社会经济处境不利的患者和CPS的心理困扰。具体的 目的和研究设计：（1）通过进行半结构化的多层次利益相关者的投入，迭代地发育迅速 与SNF临床和领导力人员（NIH型号1A）进行多达20名患者CP二元组和4个焦点小组的访谈； （2）通过进行5例患者CP二元组和退出访谈的单臂开放试点研究来完善和优化狂欢 有5名SNF员工（NIH型号1A）； （3）通过进行A的可行性，可接受性和保真度 PILOT群集随机对照试验，患者CP二元组完成了轻快（n = 30个二元）或最小增强 在3个SNF（NIH阶段1B）中通常的护理（n = 20个二元）。潜水利益相关者咨询委员会将在整个过程中召集 合作指导干预开发和改进以增强相关性和现实世界的奖励期 轻快的收养潜力。培训：我制定了一项严格的培训计划，旨在支持研究目的 并结束该提案的目标，并帮助我与我一起以患者为独立的研究员的职业生涯 改善SNF中受到社会经济打扰的患者和家庭的心理护理的长期职业目标。 具体的培训目标是：（1）干预开发和优化方面的发展技能； （2）获取技能 临床试验研究，包括统计分析，在SNF中具有二元组； （3）获得研究技能 在社会经济上处于不利地位的老年人和家庭，旨在促进健康公平。研究 马萨诸塞州综合医院和哈佛医疗以及我的多学科心态的环境 具有独特的专业知识领域，将有助于确保成功实现培训目标。影响： 我是一名临床老年心理学家，在急性后和长期护理环境中具有专业知识。我的最终任务是 开发可行，可扩展和可持续的心理干预，以改善双重资格患者的护理 他们的CP接受了急性后SNF护理。该K23提案中概述的研究和培训目标将为 未来临床试验的基础，以测试有效性效应，并最终传播和实施 在SNF中接受急性后护理后的社会经济不利的患者CP二元组，一个高需求且不足 人口研究。这项工作与NIA的目标保持一致，即提高应对能力并降低护理人员，家庭， 和患者压力（战略目标C；目标C-4）具有NIA优先级的人群。