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AI/AN数量将增加两倍，达到1，624，000人，而 85岁以上的人口将增加7倍，达到30万人。这些趋势引起了人们的关注， AI/AN老年人中的阿尔茨海默病和相关痴呆（ADRD），以及ADRD的并发需求 医疗保健和服务。许多人工智能/人工智能通过一个碎片化的系统获得医疗保健， 老年或专科护理，并为获得高质量护理制造障碍，导致诊断延迟或诊断不足 对ADRD的护理不足。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。的重点 2016年阿尔茨海默病相关痴呆症峰会旨在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。PCP特别适合检测 轻度认知障碍，通常无法诊断。虽然研究表明，临床层面的干预措施可以 改善ADRD诊断和护理，没有务实的试验集中在为AI/AN服务的设施或PCP上。在 因此，我们与一家为人工智能/人工智能服务的城市诊所合作，设计了“印度人改变阿尔茨海默氏症护理” 培训”（INTACT），一种临床水平的干预措施，旨在改善ADRD诊断和AI/AN的护理质量。的 INTACT的积极主要组成部分是PCP在ADRD筛查、诊断和护理方面的培训。其他 内容包括患者和家庭教育、文化信息视频和小册子，以创建一个“痴呆症- 友好诊所”。首先，我们将对农村诊所的PCP进行关键知情人访谈，以适应现有的 INTACT的一个版本，用于农村地区。第二，我们将在14岁时进行一项分组随机试验， 城市和14个农村诊所，使用等待控制设计为AI/AN提供初级保健。在临床层面，我们 将依靠电子病历记录INTACT对新ADRD诊断的影响。在五氯苯酚一级， 我们将测试INTACT是否增加了痴呆症评估、ADRD中自我报告的知识和信心 护理和护理人员支持。第三，我们将评估INTACT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，但我们会检查患者水平的护理质量指标 记录在患有ADRD的AI/AN的电子病历中。我们的具体目标是：1）适应完整性 2）进行GRT以测试INTACT对PCP对ADRD知识的影响， 护理信心和实践行为; 3）评估INTACT对临床水平结果的影响（新 诊断）和患者水平的护理结果质量（例如，常用于ADRD的治疗）。快速 老年AI/AN人口的增长预测了面临ADRD风险的土著老年人数量的激增。本研究 这将是为数不多的临床干预试验之一，突出了PCP教育和培训，以改善 ADRD护理，也是唯一为AI/AN社区设计的护理。

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.