The Role of Visit Audio Recordings in Triadic Dementia Care

项目总结 在美国，每九名65岁或以上的人中就有一人患有阿尔茨海默病(AD)或与阿尔茨海默病相关的疾病 痴呆症(ADRD)。痴呆症患者(PLWD)及其护理伙伴依赖初级保健诊所就诊 用于痴呆症信息、管理和社区转介。高质量的人际沟通是 与改善与健康相关的结果有关。三元互动的模型声称信息 交流、融洽，以及患者和护理合作伙伴在目标设定和决策方面的参与是 有效的人际沟通。然而，有效的人际沟通的程度 在三人访问期间取得的成果是未知的，也没有什么干预措施来支持这一点。使用以下音频记录 诊所就诊是一种新的、基于证据的策略，具有支持三元互动的潜力，但它的应用 在痴呆症方面还未被研究过。这项提议的目标是设计一种加强人际关系的干预 使用访问录音进行三人访问中的交流。申请者将遵循NIH阶段模式重新设计他们的 访问记录平台HealthPAL，它利用自然语言处理来组织访问信息。 具体目标是：目标1(阶段0)：进行前瞻性观察性研究，门诊就诊 200名三合会(PLWD/护理伙伴/临床医生)录音12个月；1.A.考察两者之间的关联 AD/ADRD三联体就诊中的人际沟通和健康相关结果；确定障碍和 促进AD/ADRD三部曲访问中的人际沟通；目标2(阶段1A)：使HealthPAL适应 在AD/ADRD三级访问中加强人际沟通；和目标3(阶段1B)：展示 HealthPAL在AD/ADRD中的可用性、可行性、可接受性和潜在有效性。申请者假设： 1)人际沟通模型的结构将与健康相关的结果相关；2) HealthPAL将超过对双方和临床医生的可用性、可行性和可接受性标准。在AIM 1申请者 将采用说明性的顺序混合方法设计。由行为更改控制盘通知，目标为 行为改变将通过对三部曲期间人际沟通的定量评估来确定 访问(200对夫妇，每年访问3次；∼访问600次)，辅之以有目的的半结构化采访 1a三和弦样本(n=42)；在目标2中，我们将使用参与式设计方法(n=60)重新设计HealthPAL 使用目标1的结果；在目标3中，我们将使用开放标签、单臂、多站点试点试验(n=30)来 确定HealthPAL的可用性、可行性和可接受性，并收集有关其影响的初步数据 AD/ADRD三联体访问中的人际沟通。这项工作是改进PLWD的必要的第一步 通过确定影响人际沟通的行为及其与健康的关联来进行三元护理- 相关结果。制定的干预措施和收集的广泛数据将成为一项强大的 可用于解决与PLWD护理相关的临床知识的其他空白的资源。

PROJECT SUMMARY One in nine people aged 65 or older in the US lives with Alzheimer's disease (AD) or Alzheimer's disease-related dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits for dementia information, management, and community referrals. Quality interpersonal communication is associated with improved health-related outcomes. Models of triadic interactions purport that information exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to effective interpersonal communication. However, the degree to which effective interpersonal communication is achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application is unexplored in dementia. The objective of this proposal is to design an intervention that enhances interpersonal communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their visit recording platform, HealthPAL, which leverages natural language processing to structure visit information. The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of 200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD. Applicants hypothesize: 1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2) HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for behavior change will be identified using quantitative assessment of interpersonal communication during triadic visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on interpersonal communication in triadic AD/ADRD visits. This work is a necessary first step to improving PLWD triadic care by identifying behaviors that impact interpersonal communication and their associations with health- related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.