Implementation of EIT-4-BPSD in Nursing Homes

EIT-4-BPSD 在疗养院的实施

基本信息

批准号：
9174315
负责人：
ANN M KOLANOWSKI
金额：
$ 51.04万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-23 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9174315
关键词：
Adoption Adverse event Aggressive behavior Agitation Antipsychotic Agents Anxiety Behavior Therapy Behavioral Behavioral Symptoms Belief Caring Clinical Trials Cluster randomized trial Cost utility Data Dementia Discipline of Nursing Education Effectiveness Ensure Environment Evaluation Evidence based intervention Evidence based practice Exhibits Family Focus Groups Funding Goals Hallucinations Health Hybrids Individual Intervention Knowledge Long-Term Care Maintenance Measures Mental Depression Mentors Methods Modeling Motivation Nursing Homes Outcome Outcome Measure Outcomes Research Peer Review Personal Satisfaction Pharmaceutical Preparations Physical Function Physical Restraint Policies Process Provider Quality of life Randomized Research Research Personnel Resources Risk Social isolation Surveys Testing United States Centers for Medicare and Medicaid Services United States National Institutes of Health Work abstracting base cost dementia care effective intervention evidence base experience improved improved functioning novel person centered pragmatic trial prevent programs psychological symptom skills

项目摘要

Abstract Behavioral and Psychological Symptoms of Dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home residents with dementia. For residents, BPSD contribute to negative health outcomes, a decline in physical functioning, and may increase the inappropriate use of antipsychotic drugs (AP) and physical restraints. BPSD also contribute to the high cost of long term care. We, and other researchers, have shown that behavioral approaches can reduce BPSD. The Centers for Medicare and Medicaid Services (CMS) in their National Partnership to Improve Dementia Care and Reduce Antipsychotic Use in Nursing Homes has now focused regulatory efforts during the nursing home survey on ensuring that care for residents with dementia is delivered using person-centered behavioral approaches. Person-centered care is focused on collaborative partnerships among individuals, their families and providers and emphasizes health and well-being by being responsive to an individual's priorities, goals and needs. Unfortunately, less than 2% of nursing homes have implemented these changes. The major barriers to use of behavioral approaches are limited knowledge, skills and motivation of staff to utilize these approaches. The proposed research responds to the need to implement a person-centered approach to management of BPSD by testing evidence-based practice for BPSD under conditions of an implementation strategy referred to as the Evidence Integration Triangle (EIT). We worked with CMS to advance the National Partnership and developed a comprehensive compendium of peer-reviewed/expert- endorsed resources for utilizing person-centered, behavioral approaches to BPSD (i.e., a Nursing Home Toolkit; nursinghometoolkit.com). To facilitate implementation of the person-centered behavioral management of BPSD we merged the Toolkit and our previously tested 4-step approach as a way to overcome the barriers to implementation. The steps include: Step 1. Assessment of the Environment and Policies; Step 2. Education of Staff; Step 3. Establishing Person Centered Care Plans; and Step 4. Mentoring and Motivating of Staff) with the EIT implementation strategy to develop the EIT-4- BPSD. We propose a cluster randomized trial with 50 nursing homes randomized to EIT-4-BPSD or Education Only (EO). Our aims are to: 1: implement and test EIT-4-BPSD; and 2: evaluate use of the EIT strategy and our participatory implementation process with staff. The findings from this study will add to what is known about implementation of effective interventions in nursing homes, will serve as a model for other programs and care approaches, and will help facilities and staff implement quality person-centered care, the ultimate goal of the National Partnership.

抽象的痴呆症的行为和心理症状 (BPSD) 包括攻击性、激动、抑郁、高达 90% 的老年痴呆症疗养院居民都表现出焦虑、冷漠和幻觉。对于居民来说，BPSD 会导致负面的健康结果、身体机能下降，并可能增加抗精神病药物（AP）和身体束缚的不当使用。 BPSD 还有助于长期护理费用高。我们和其他研究人员已经表明，行为方法可以减少 BPSD。医疗保险和医疗补助服务中心 (CMS) 在其全国合作伙伴关系中改善痴呆症护理和减少疗养院抗精神病药物的使用现在已将监管工作重点放在关于确保以人为本的方式为痴呆症居民提供护理的疗养院调查行为方法。以人为本的护理侧重于个人之间的合作伙伴关系，他们的家人和提供者，并通过响应个人的需求来强调健康和福祉优先事项、目标和需求。不幸的是，只有不到 2% 的疗养院实施了这些变革。使用行为方法的主要障碍是员工的知识、技能和积极性有限。利用这些方法。拟议的研究响应了实施以人为本的需要通过在以下条件下测试 BPSD 的循证实践来管理 BPSD 实施策略称为证据整合三角（EIT）。我们与 CMS 合作推进国家伙伴关系，并制定了经过同行评审/专家的综合纲要认可资源，利用以人为本的行为方法来解决 BPSD（即疗养院工具包； nursinghometoolkit.com）。促进实施以人为本的行为管理在 BPSD 中，我们将工具包和我们之前测试过的 4 步方法合并起来，作为克服障碍的一种方法到实施。步骤包括：步骤1.环境和政策评估；第二步：教育员工人数；第 3 步：建立以人为本的护理计划；和步骤 4. 指导和激励员工）制定 EIT-4- BPSD 的 EIT 实施策略。我们建议进行一项整群随机试验，其中 50 疗养院随机分配至 EIT-4-BPSD 或仅教育组 (EO)。我们的目标是： 1：实施和测试 EIT-4-BPSD； 2：评估 EIT 战略的使用以及我们与员工的参与式实施流程。这项研究的结果将增加对实施有效护理干预措施的了解之家，将作为其他计划和护理方法的典范，并将帮助设施和工作人员实施以人为本的优质护理，这是国家伙伴关系的最终目标。