METRIcAL - Music & MEmory: a Pragmatic TRIal for Nursing Home Residents with ALzheimer's Disease

项目总结 针对行为和心理症状的循证、非药物干预 痴呆症(BPSD)是疗养院(NHS)特别优先考虑的问题，超过50%的长期住院患者 居民患有阿尔茨海默病相关痴呆(ADRD)和非标签抗精神病药物的使用 由于严重的不良后果，治疗BPSD的药物是禁忌的。 研究表明，个性化的音乐可以减少焦虑，减少负面情绪或 抑郁，并控制ADRD患者的身体激动行为。用音乐唤起记忆 熟悉或喜欢的音乐可能会减少孤立感和焦虑感，因为音乐记忆是编码的 在ADRD过程中受影响较晚的大脑区域，而不是涉及言语记忆和 执行功能。MUSIC&MEMORYSM(M&M)是一个使用廉价iPod的音乐程序 为ADRD患者提供个性化音乐的技术。这种干预的潜力得到了说明。 在2014年获奖的纪录片《活着》中表现得非常有力，这部纪录片展示了患有严重痴呆症的居民 在iPod上听他们最喜欢的音乐时，开始移动、唱歌和与他人互动。回顾 布朗大学的分析发现，在参与NHS的居民中，BPSD症状下降得更快 M&M与配对对照。然而，国家示范项目和其他项目证明了 M&M的实施方式差异很大。作为标准化项目交付和评估的第一步 效率，布朗及其合作伙伴开发了一份实施指南，整合了全州范围内的经验 关于NH最佳做法的定性数据的努力。 我们建议在为期一年的R21试点期间标准化M&M的引入和实施，并 然后测试实施M&M对NH居民在四年R33期间BPSD结果的影响 务实的审判。在试点期间，我们将测试分步协议，并验证数据传输和 四个不同的NHS的测量程序，来自四个参与公司中的每一个； 务实试验，我们将进行楔形、务实的整群随机对照试验(RCT)和 评估M&M对居民行为和用药的影响，并检查影响因素 与NHS在66个设施中遵守该计划的情况不同有关。使用等待列表控件设计 将允许我们根据需要反复改进培训和测量，在参与的浪潮之间 设施。在试点和务实试验中，我们将把该计划作为设施级、协议- 推动的质量改进项目，目标是所有符合条件(中度至重度ADRD)的居民参与 设施。我们将使用iPod元数据、电子健康记录数据和最小数据集进行分析 居民评估，所有这些都可以与联邦医疗保险登记和重要状态数据相关联。

PROJECT SUMMARY Evidence-based, non-pharmacological interventions that address the behavioral and psychological symptoms of dementia (BPSD) are a particularly high priority for nursing homes (NHs), where over 50% of long-stay residents have Alzheimer's disease-related dementias (ADRD) and the off-label use of antipsychotic medications to address BPSD is contraindicated due to serious adverse consequences. Studies have demonstrated that individualized music can reduce anxiety, decrease negative affect or depression, and control physically-agitated behaviors in people with ADRD. Eliciting musical memories using familiar or preferred music may decrease feelings of isolation and anxiety, as musical memories are encoded in areas of the brain affected later in the ADRD process than areas of the brain involved in verbal memory and executive functioning. MUSIC & MEMORYSM (M&M) is a music program that involves using inexpensive iPod technology to deliver individualized music to people with ADRD. The intervention's potential is illustrated powerfully in the award-winning 2014 documentary, Alive Inside, which shows residents with severe dementia begin to move, sing, and interact with others when listening to their favorite music on iPods. Retrospective Brown University analyses found that residents' BPSD symptoms decreased faster among NHs participating in M&M vs. pair-matched controls. However, state demonstration programs and other projects demonstrate that implementation of M&M varies widely. As a first step to standardizing delivery of the program and evaluating efficacy, Brown and its partners developed an implementation guide, integrating experiences from statewide efforts with qualitative data about NH best practices. We propose to standardize the introduction and implementation of M&M during a one-year R21 pilot and then to test the impact of implementing M&M on NH residents' BPSD outcomes during a four-year R33 pragmatic trial. During the pilot, we will test a step-by-step protocol and validate data transfer and measurement procedures in four different NHs, one from each of four participating corporations; during the pragmatic trial, we will conduct a wedge-based, pragmatic cluster randomized controlled trial (RCT) and estimate the impact of M&M on residents' behaviors and medication use, as well as examine factors associated with variation in NHs' adherence to the program in 66 facilities. Using a waiting list control design will allow us to iteratively refine training and measurement, as needed, between waves of participating facilities. In both the pilot and the pragmatic trial, we will implement the program as a facility-level, protocol- driven, quality improvement project, targeting all eligible (moderate to severe ADRD) residents in participating facilities. We will conduct analyses using iPod metadata, electronic health record data, and Minimum Data Set resident assessments, all of which can be linked to Medicare enrollment and vital status data.