Utilizing the RESCUE Stroke Caregiver Website to Enhance Discharge Planning

利用 RESCUE 中风护理人员网站加强出院计划

• 批准号: 10179460
• 负责人: CONSTANCE R. UPHOLD
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179460
• 关键词: Activities of Daily Living; American Stroke Association; Caregiver Burden; Caregivers; Caring; Clinic Visits; Computerized Patient Records; Control Groups; Coupled; Data; Day Care; Decision Support Systems; Depth Perception; Discharge Plannings; Disease model; E-learning; Emergency department visit; Enrollment; Family member; Fees; Florida; Geriatrics; Goals; Health Care Costs; Health system; Healthcare Systems; Home environment; Institutionalization; Intervention; Interview; Lead; Length of Stay; Long-Term Care; Measures; Methods; Modeling; Nurses; Nursing Services; Office Nursing; Outcome; Patient Discharge; Patients; Perception; Persons; Phase; Policy Maker; Problem Solving; Process; Provider; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Recovery; Research; Research Assistant; Research Personnel; Role; Secure; Self Efficacy; Site; Stroke; Survivors; Technology; Telephone; Testing; Text; Time; Training; Translations; Travel; Validity and Reliability; Veterans; Veterans Hospitals; Visit; Work; attentional control; caregiver depression; caregiver education; caregiving; clinical practice; cost; depressive symptoms; encryption; evidence base; experience; firewall; follow-up; functional outcomes; group intervention; health care service utilization; health record; health related quality of life; high risk; hospital bed; hospital readmission; improved; instrument; intervention cost; intervention effect; novel; post stroke; programs; satisfaction; skills training; stroke intervention; stroke survivor; tool; treatment as usual; web site

DESCRIPTION (provided by applicant): Background: Caregiver depression is common following a family member's stroke and is a major contributor of survivor's hospital readmission and institutionalization. Researchers have consistently found that interventions to help caregivers resolve problems are effective in reducing depressive symptoms. However, these problem-solving interventions have been underused in practice because they involve multiple, in-person or telephone sessions and require large amounts of staff time to implement. To overcome these barriers, our long-term goal is to implement stroke caregiver programs that involve low-cost interventions that are sustainable in routine clinical practice. Our immediate objective is to test, using a randomized controlled trial, a problem-solving intervention for stroke caregivers that can be delivered during the Veterans' in-patient stays followed by online, in-home sessions. We will modify the traditional, problem-solving intervention by adding web-based training using interactive modules, factsheets, and tools on our previously developed and nationally available RESCUE Caregiver website (www.rorc.research.va.gov/rescue). We will also provide on-line, skills training and application of the problem-solving approach via the RESCUE messaging center, a secure site behind the VA firewall. This work builds on the team's extensive experience in stroke caregiver education. Our immediate, primary aim (#1) is to test the effect of the intervention on stroke caregivers' depressive symptoms at 14 weeks post-discharge from in-patient settings. Primary Hypothesis: Stroke caregivers who receive the intervention will have less depressive symptoms at 14 weeks compared to stroke caregivers in the attention control group. We propose four secondary aims. Aim #2 is to test the effect of the intervention on stroke caregivers' burden, problem-solving abilities, self-efficacy, health-related quality of life (HRQOL, and satisfaction with care at 14 weeks post-discharge. Aim #3 is to test the effect of the intervention on Veterans' outcomes: functional abilities and healthcare utilization (i.e., unintended hospital bed days of care, number of emergency room visits, number of unscheduled clinic visits) at 14 weeks post-discharge. Aim #4 is to determine the budgetary impact for implementing the intervention. Aim #5 is to determine the facilitators, barriers and best practices for implementing the intervention. Methods: We will conduct a two-group randomized controlled trial with repeated measures and use mixed methods to determine caregivers' perceptions of the intervention. We will enroll 240 stroke caregivers at 3 study sites (North Florida/South Georgia Veterans Healthcare System, Miami VA Healthcare System, and James A. Haley Veterans Hospital in Tampa) in VISN8. Eligible caregivers will be interviewed, complete baseline measures, and then be randomized to two groups: 1) intervention group, or 2) attention control group. A research assistant (RA) will telephone caregivers at 7 weeks and 14 weeks to answer questions on instruments with established reliability and validity. The RA will review the Veterans' VA Computerized Patient Record System health record to obtain information on the Veterans' healthcare utilization. We will determine the budgetary impact of the intervention by examining the cost data in the Decision Support System National Data Extracts and VA fee-basis files. Qualitative interviews will be conducted with selected caregivers to obtain in-depth perceptions of the value, facilitators, and barriers of the intervention. Throughout all phases of the project, we will collaborate with our VA (Offices of Nursing Service, Office of Geriatrics and Extended Care, My HealtheVet Program Office, Stroke QUERI Center) and non-VA partners (American Stroke Association). Impact: This is the first known study to test a discharge-planning intervention combined with technology to improve the quality of caregiving and the recovery of Veterans. Other outcomes will be a state-of-the-art website and an evidence-based model (in-patient, discharge planning and online, training and caregiver-provider messaging) that can be transportable to other disease models.

描述（由申请人提供）： 背景：护理人员抑郁症在家庭成员中风后很常见，是幸存者重新入院和住院的主要原因。研究人员一致发现，帮助护理人员解决问题的干预措施可以有效减少抑郁症状。然而，这些解决问题的干预措施在实践中并未得到充分利用，因为它们涉及多次面对面或电话会议，并且需要员工大量时间来实施。为了克服这些障碍，我们的长期目标是实施中风护理人员计划，其中涉及在常规临床实践中可持续的低成本干预措施。我们的近期目标是使用随机对照试验来测试中风护理人员解决问题的干预措施，该干预措施可以在 退伍军人住院后进行在线家庭治疗。我们将修改传统的解决问题的干预措施，通过添加基于网络的培训，使用交互式模块、情况说明书和我们之前开发的全国可用的救援护理人员网站 (www.rorc.research.va.gov/rescue) 上的工具。我们还将通过 RESCUE 消息中心（VA 防火墙后面的安全站点）提供在线技能培训和问题解决方法的应用。这项工作建立在团队在中风护理人员教育方面的丰富经验的基础上。我们的直接主要目标 (#1) 是测试干预措施对中风护理人员出院后 14 周的抑郁症状的效果。主要假设：与注意力对照组的中风护理人员相比，接受干预的中风护理人员在第 14 周时的抑郁症状较少。我们提出四个次要目标。目标 #2 是测试干预对中风护理人员的负担、解决问题的能力、自我效能、健康相关生活质量 (HRQOL 以及出院后 14 周的护理满意度) 的影响。目标 #3 是测试干预对退伍军人结果的影响：功能能力和医疗保健利用率（即非预期的住院床位护理天数、急诊室就诊次数、出院后 14 周的护理满意度）。 出院后 14 周进行的计划外就诊）。目标#4 是确定实施干预措施的预算影响。目标 5 是确定实施干预措施的促进因素、障碍和最佳实践。方法：我们将进行一项两组随机对照试验，通过重复测量并使用混合方法来确定护理人员对干预的看法。我们将在 3 个研究中心（北 佛罗里达州/南乔治亚退伍军人医疗保健系统、迈阿密退伍军人医疗保健系统和坦帕的 James A. Haley 退伍军人医院）位于 VISN8。符合资格的护理人员将接受采访，完成基线测量，然后被随机分为两组：1) 干预组，或 2) 注意力对照组。研究助理 (RA) 将在 7 周和 14 周时致电护理人员，回答有关已确定可靠性和有效性的仪器的问题。 RA 将审查退伍军人的 VA 计算机化患者记录系统健康记录，以获取有关退伍军人医疗保健利用率的信息。我们将通过检查决策支持系统国家数据摘录和 VA 费用基础文件中的成本数据来确定干预措施的预算影响。将与选定的护理人员进行定性访谈，以深入了解干预的价值、促进因素和障碍。在该项目的所有阶段，我们将与 VA（护理服务办公室、老年病学和延伸护理办公室、My HealtheVet 项目办公室、中风 QUERI 中心）和非 VA 合作伙伴（美国中风协会）合作。影响：这是第一项已知的研究，旨在测试出院计划干预措施与技术相结合，以提高护理质量和退伍军人的康复。其他成果将是一个最先进的网站和一个可移植到其他疾病模型的基于证据的模型（住院、出院计划和在线、培训和护理人员信息传递）。