Development and pilot testing of a behavioral economics mobile health digital tool to improve adherence to non-pharmacologic strategies for behavioral and psychological symptoms of dementia

项目总结/摘要： 背景：目前有500多万美国人患有阿尔茨海默病及其相关疾病。 到2050年，这一数字预计将增加到近1 400万。最常见的症状之一 患有痴呆症（PLWD）的人是行为和心理障碍。PLWD需要护理 伴侣自己也面临着包括内疚，抑郁，情绪和身体压力在内的挑战， 痴呆的行为和心理症状（BPSD）。美国老年医学会（American Geriatrics Society） 目前不鼓励使用抗精神病药物治疗BPSD，而是鼓励非药物治疗 接近。虽然一些用于解决BPSD的非药物策略已被证明是有效的， 坚持是具有挑战性的。来自行为经济学（BE）的新概念，这是一个结合了 经济学和心理学认识到人类经常会犯可预测的决策错误， 在各种医疗保健环境中促进适当的疾病管理。移动的健康 技术是提供非药物治疗的一种机制;然而，迄今为止， 纳入BE原则，以提高对非药物策略管理BPSD的依从性。 研究：这项研究将利用BE与mHealth的力量来开发，用户测试和试点数字健康 旨在改善BPSD非药物策略依从性的工具。彻底审查 文献、利益相关者访谈和设计思维研讨会将有助于BE推动的发展。 将对艾滋病毒/艾滋病感染者-护理伙伴二人组进行访问，并进行半结构化电话访谈， 并完善BE-mHealth数字工具原型。这项工作的高潮将是一个干预准备， 通过纽约大学Langone健康（NYULH）系统内的单臂、6个月的试点研究进行测试。 主要研究结局将是对非药物策略的依从性，次要结局 将包括BPSD的变化、护理伴侣负担和抗精神病药物处方。社会的，社会的 人口统计学、临床和主要/次要研究结局将使用护理伙伴报告的数据进行测量 结果和嵌入在BE-mHealth工具中的患者电子健康记录，以便于数据采集。 培训：候选人提出的培训计划建立在BE设计和测试的前期研究基础上 通过嵌入式实用临床试验进行数字健康干预。候选人将接受实地培训 痴呆症，数字健康创新，实施科学和混合方法研究，通过一对一， 一个导师，课程，研讨会，讲习班，并在高度相关的学科会议， 提议的研究。导师团队由具有工作经验的特定学科专家组成 与候选人一起参与NIH资助的赠款提案和同行评审的出版物。候选人的 长期目标是成为开发和测试BE启发的数字 对痴呆症患者的慢性病管理进行健康干预。

PROJECT SUMMARY / ABSTRACT: Background: There are currently more than five million Americans living with Alzheimer’s disease and related dementias, a number expected to increase to nearly 14 million by 2050. Among the most common symptoms of persons living with dementia (PLWD) are behavioral and psychological disturbances. PLWD require care partners who themselves face challenges including guilt, depression, and emotional and physical stress due to the behavioral and psychological symptoms of dementia (BPSD). Guidelines by the American Geriatrics Society currently discourage antipsychotic prescriptions to treat BPSD, instead encouraging non-pharmacological approaches. While some non-pharmacologic strategies for addressing BPSD have shown to be effective, adherence is challenging. Novel concepts from behavioral economics (BE), a field that combines insights from economics and psychology to recognize that humans often make predictable decision errors, has shown promise in promoting appropriate disease management in a variety of healthcare settings. Mobile health (mHealth) technology is one mechanism for delivering non-pharmacologic care; however, no strategies to date have incorporated BE principles to improve adherence to non-pharmacologic strategies for managing BPSD. Research: This study will leverage the power of BE with mHealth to develop, user-test, and pilot a digital health tool aimed at improving adherence to non-pharmacologic strategies for BPSD. A thorough review of the literature, stakeholder interviews, and a design-thinking workshop will aid in the development of the BE nudges. Visits with PLWD-care partner dyads and semi-structured telephone interviews will be conducted to user-test and refine the BE-mHealth digital tool prototype. The culmination of this work will be an intervention ready for testing via a single-arm, 6-month pilot study within the New York University Langone Health (NYULH) system. The primary study outcome will be adherence to the non-pharmacologic strategies, and secondary outcomes will include changes in BPSD, care partner burden, and prescriptions for anti-psychotic medications. Socio- demographic, clinical, and primary/secondary study outcomes will be measured using care partner reported outcomes and patient electronic health records embedded within the BE-mHealth tool for ease of data capture. Training: The candidate’s proposed training plan builds upon prior research in the design and testing of BE digital health interventions via embedded pragmatic clinical trials. The candidate will receive training in the fields of dementia, digital health innovation, implementation science, and mixed-methods research through one-on- one mentorship, coursework, seminars, workshops, and conferences in disciplines of high relevance to the proposed research. The mentorship team is composed of discipline-specific experts with a history of working together and with the candidate on NIH funded grant proposals and peer-reviewed publications. The candidate’s long-term goal is to become an independent investigator in the development and testing of BE-inspired digital health interventions for chronic disease management in persons living with dementia.