The Care Ecosystem Response to COVID-19: Accelerating Research on Dementia Care that Meets the Needs of Caregivers and Persons with Dementia during COVID-19

护理生态系统对 COVID-19 的响应：加速痴呆症护理研究，满足 COVID-19 期间护理人员和痴呆症患者的需求

• 批准号: 10324344
• 负责人: Katherine Laurel Possin
• 金额: $ 290.88万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10324344
• 关键词: Bed Occupancy; Behavior; Behavioral Symptoms; Black race; COVID-19; COVID-19 pandemic; Caregiver Burden; Caregiver support; Caregiver well-being; Caregivers; Caring; Clinical; Communication; Communities; Community Health; Complex; Data; Dementia; Dementia caregivers; Development; Discipline of Nursing; Ecosystem; Effectiveness; Electronic Health Record; Emergency department visit; Emergency medical service; Enrollment; Environment; Evaluation; Family; Family Caregiver; Fee-for-Service Plans; Fright; Future; Geography; Goals; Health Care Reform; Health Personnel; Health system; Healthcare Systems; Home; Hospitalization; Infection; Internet; Intervention; Interview; Latinx; Locales; Medical; Medicare claim; Mental Depression; Methods; Modeling; Monitor; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population Heterogeneity; Primary Health Care; Protocols documentation; Provider; Public Health; Quality of Care; Quality of life; Randomized Clinical Trials; Research; Resources; Risk; Risk Reduction; Rural; Science; Services; Site; Social Work; Specialist; Standardization; Structure; Supervision; Supportive care; Surveys; Technology; Telephone; Time; Training; Underrepresented Populations; Underserved Population; Vulnerable Populations; Work; advanced dementia; advanced disease; barrier to care; base; caregiver depression; cohort; collaborative care; comparison group; cost; dementia care; effectiveness evaluation; effectiveness study; evidence base; experience; family burden; health care model; high risk; hospital readmission; implementation barriers; implementation facilitators; implementation science; implementation strategy; improved; improved outcome; model design; pandemic disease; patient population; person centered; pragmatic trial; primary outcome; programs; racial and ethnic; racial minority population; remote delivery; remote health care; response; satisfaction; secondary outcome; social

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients and caregivers, which have been exacerbated by the COVID- 19 pandemic. The current state of dementia care is inadequate to meet the needs of this growing, vulnerable population. Scalable, effective, and person-centered dementia care models that are aligned with value-based healthcare reforms are needed now. The Care Ecosystem is an accessible, remotely delivered team-based dementia care model, designed to add value for patients, providers and payers in complex organizational and reimbursement structures. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a team of dementia specialists with nursing, social work, and pharmacy expertise. Care Protocols guide proactive, quality care that is documented in the electronic health record. The evidence base to date suggests that the Care Ecosystem improves outcomes important to people with dementia, caregivers, and payers when delivered in a controlled research environment, including reduced emergency department visits, higher quality of life for patients and lower caregiver depression. We propose a rapid pragmatic trial in 6 health systems serving geographically and culturally diverse populations. We will leverage technology, delivering care via the phone and web and using electronic health records to monitor quality improvements and evaluate outcomes while maximizing external validity. In Aim 1, we will use implementation science to identify the model adaptations, facilitators, and barriers to implementing and sustaining the Care Ecosystem during the COVID-19 pandemic. In Aim 2 we will use mixed methods to rigorously evaluate the effectiveness of the Care Ecosystem on outcomes important to patients, caregivers, healthcare providers, and health systems during the pandemic. In Aim 3, we will characterize the patient and caregiver factors associated with treatment benefit. This will include investigating effectiveness in underrepresented groups and elucidating unmet needs that will guide future development work. By simultaneously evaluating the real-world effectiveness and implementation strategies in diverse health systems, this project will bridge the science-practice gap in dementia care during an unprecedented time of heightened strain on family caregivers, healthcare providers and health systems. Furthermore, this work will pave the way for expanding access to high quality dementia care in the future, mitigating the negative impact of dementia on patients and their families across the nation.

项目总结/摘要 痴呆症给患者和护理人员造成了沉重的负担，而新冠肺炎又加剧了这种负担- 19大流行病。目前的痴呆症护理状况不足以满足这一日益增长的脆弱群体的需求。 人口可扩展、有效和以人为本的痴呆症护理模式，与基于价值的 现在需要医疗改革。护理生态系统是一个可访问的、远程交付的、基于团队的 痴呆症护理模式，旨在为患者，提供者和支付者在复杂的组织和 偿还结构。护理是通过电话和网络提供的未经许可的护理团队导航，谁 由一组具有护理、社会工作和药学专业知识的痴呆症专家进行培训和监督。 护理协议指导记录在电子健康记录中的积极主动的高质量护理。证据 迄今为止的基础表明，护理生态系统改善了对痴呆症患者重要的结果， 在受控的研究环境中交付时，包括减少紧急情况， 部门访问，更高的生活质量的病人和更低的照顾者抑郁症。我们提出了一个快速实用的 在为地理和文化多样性人群服务的6个卫生系统中进行试验。我们将利用技术， 通过电话和网络提供护理，并使用电子健康记录来监测质量改进， 评估结果，同时最大限度地提高外部有效性。在目标1中，我们将使用实施科学来识别 模型适应，促进者，以及在实施和维持护理生态系统期间的障碍 2019冠状病毒病大流行。在目标2中，我们将使用混合方法来严格评估护理的有效性 生态系统对患者，护理人员，医疗保健提供者和卫生系统的重要结果 流行病在目标3中，我们将描述与治疗获益相关的患者和护理人员因素。 这将包括调查在代表性不足的群体中的有效性，并阐明未满足的需求， 指导今后的发展工作。通过同时评估现实世界的有效性和实施情况， 在不同的卫生系统的战略，该项目将弥合科学实践的差距，在痴呆症护理期间， 家庭护理人员、医疗保健提供者和卫生系统面临前所未有的压力。 此外，这项工作将为未来扩大获得高质量痴呆症护理铺平道路， 减轻痴呆症对全国患者及其家庭的负面影响。