Indian Transforming Alzheimer's Care Training

研究项目1：摘要 美国印第安人和阿拉斯加原住民(AI/AN)的人口增长速度是美国所有种族的3倍 人口。预计到2050年，65岁以上的人工智能/人工智能的数量将增加两倍，达到1,624,000人，而 85岁以上的人将增加7倍，达到30万人。这些趋势引发了人们对按比例增长的担忧 AI/AN老年人中的阿尔茨海默病和相关痴呆(ADRD)，以及对ADRD的同时需求 医疗保健和服务。许多人工智能/人工智能通过分散的系统获得医疗保健，该系统提供最低限度的 老年或专科护理，对获得高质量的护理造成障碍，导致延误或诊断不足 以及对ADRD的照顾不足。AI/AN老年人通常从初级保健医生那里获得医疗保健 (PCP)，他们往往缺乏诊断和管理ADRD所需的培训和资源。这次会议的重点是 2016年阿尔茨海默病相关痴呆症峰会主题是通过培训提高社区技能 痴呆症诊断、护理和研究方面的卫生专业人员。多氯联苯尤其适合检测 轻度认知障碍，通常未被诊断出来。虽然研究表明，临床层面的干预可以 在改善ADRD诊断和护理方面，没有一项务实的试验将重点放在为AI/ANS服务的设施或PCP上。在……里面 因此，我们与一家提供人工智能/ANS服务的城市诊所合作，设计了“印度人改造阿尔茨海默氏症护理” 培训“(完好无损)，这是一项诊所一级的干预措施，旨在改善对人工智能/ANS的ADRD诊断和护理质量。这个 INTERNAL的有效主成分是PCP培训，用于ADRD的筛查、诊断和护理。其他 内容包括患者和家庭教育，了解文化知识的视频和宣传手册，以创造“痴呆症-- 友好的诊所“。首先，我们将与乡村诊所的初级保健医生进行关键的线人访谈，以适应现有的 原封不动的版本在农村地区交付。第二，我们将在14点进行一组随机试验，测试完好无损 城市和14个农村诊所，使用等待控制设计为人工智能/ANS提供初级保健。在诊所层面，我们 将依靠电子医疗记录来记录完整的对新的ADRD诊断的影响。在五氯苯酚层面， 我们将测试完整是否增加痴呆评估的自我报告知识和信心，ADRD 关爱和护理者支持。第三，我们将评估INTENAL对临床和患者水平结果的影响。 虽然我们不会直接从患者那里收集数据，但我们会检查患者级别的护理质量指标 记录在人工智能/ANS和ADRD的电子医疗记录中。我们的具体目标是：1)完好无损地适应 用于为人工智能/ANS提供服务的农村诊所；2)进行GRT以测试INTERNAL对PCP对ADRD知识的影响， 护理信心和实践行为；以及3)评估INTERNAL对临床结果的影响(新 诊断)和患者层面的护理质量(例如，ADRD常用的治疗方法)。The Rapid 老年AI/AN人口的增长预测，患有ADRD风险的土著老年人数量将激增。本研究 这将是为数不多的以PCP教育和培训为重点的临床层面干预试验之一 ADRD关怀，也是唯一一款专为AI/AN社区设计的。

RESEARCH PROJECT 1: ABSTRACT The American Indian and Alaska Native (AI/AN) population is growing 3 times faster than the US all-races population. The number of AI/ANs aged 65+ is expected to triple to 1,624,000 by 2050, while the number of those aged 85+ will increase 7-fold to 300,000. These trends raise concerns about proportionate increases in Alzheimer’s disease and related dementias (ADRD) among AI/AN elders, and concurrent demands for ADRD healthcare and services. Many AI/ANs obtain healthcare through a fragmented system that offers minimal geriatric or specialty care and creates barriers to obtaining high-quality care, resulting in late or under-diagnosis and inadequate care for ADRD. AI/AN elders typically receive their healthcare from primary care physicians (PCPs), who often lack the training and resources needed to diagnose and manage ADRD. The focus of the 2016 Alzheimer’s Disease-Related Dementias Summit was on improving skills in the community by training health professionals in dementia diagnosis, care, and research. PCPs are especially well-placed to detect mild cognitive impairment, which is often undiagnosed. While studies suggest that clinic-level interventions can improve ADRD diagnosis and care, no pragmatic trial has focused on facilities or PCPs that serve AI/ANs. In partnership with an urban clinic serving AI/ANs, we therefore designed “INdians Transforming Alzheimer’s Care Training” (INTACT), a clinic-level intervention to improve ADRD diagnosis and quality of care for AI/ANs. The active principal component of INTACT is PCP training in screening, diagnosis, and care for ADRD. Other elements include patient and family education, culturally informed videos, and brochures to create a “dementia- friendly clinic”. First, we will conduct key informant interviews with PCPs in rural clinics to adapt the existing version of INTACT for delivery in rural settings. Second, we will test INTACT with a group-randomized trial at 14 urban and 14 rural clinics that provide primary care to AI/ANs using a wait-control design. At the clinic level, we will rely on electronic medical records to document INTACT’s effect on new ADRD diagnoses. At the PCP level, we will test whether INTACT increases self-reported knowledge and confidence in dementia assessment, ADRD care, and caregiver support. Third, we will evaluate INTACT’s effect on clinic- and patient-level outcomes. Although we will not collect data directly from patients, we will examine patient-level quality of care metrics documented in electronic medical records for AI/ANs with ADRD. Our Specific Aims are to: 1) Adapt INTACT for use in rural clinics serving AI/ANs; 2) Conduct a GRT to test INTACT’s effects on PCP knowledge of ADRD, care confidence, and practice behavior; and 3) Evaluate INTACT’s effect on clinic-level outcomes (new diagnoses) and patient-level quality of care outcomes (e.g., treatments commonly used for ADRD). The rapid growth of the elderly AI/AN population forecasts a ballooning number of Native elders at risk of ADRD. This study will be one of the few trials of a clinic-level intervention that foregrounds PCP education and training to improve ADRD care, and the only one designed for AI/AN communities.