The Role of Visit Audio Recordings in Triadic Dementia Care

探访录音在三元痴呆护理中的作用

• 批准号: 10437386
• 负责人: PAUL JAMES BARR
• 金额: $ 85.86万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437386
• 关键词: Accountability; Address; Adherence; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care Facilities; Behavior; Caring; Clinic; Clinic Visits; Clinical; Communication; Communities; Computer software; Data; Decision Making; Dementia; Effectiveness; Emotional; Family; Federally Qualified Health Center; Feedback; Funding; Future; Geography; Goals; Health; Health Services; Information Management; Intervention; Interview; Knowledge; Lebanon; Linguistics; Logistics; Maps; Methods; Modeling; Motivation; Natural Language Processing; Observational Study; Outcome; Patient Care; Patient Preferences; Patients; Performance; Personal Communication; Persons; Play; Primary Health Care; Process; Provider; Quality of life; Readiness; Recommendation; Reporting; Research; Resources; Role; Roter; Rural; Sampling; Schedule; Site; Structure; System; Systems Analysis; Techniques; Triad Acrylic Resin; Trust; United States National Institutes of Health; Visit; Work; acceptability and feasibility; aged; arm; behavior change; behavior change wheel; cognitive load; dementia care; design; evidence base; experience; follow-up; improved; improved outcome; information processing; innovation; novel; open label; pilot trial; prospective; psychosocial; racial and ethnic; satisfaction; skills; software development; theories; therapy design; tool; trustworthiness; usability

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.

项目摘要 在美国，每九个65岁或以上的人中就有一个患有阿尔茨海默病（AD）或阿尔茨海默病相关疾病。 痴呆（ADRD）。痴呆症患者（PLWD）及其护理伙伴依赖初级保健诊所就诊 痴呆症信息、管理和社区转诊。高质量的人际沟通是 与改善健康相关的结果相关。三元互动模型声称， 交流、融洽、患者和护理伙伴参与目标设定和决策是 有效的人际沟通。然而，有效的人际沟通在多大程度上 在三重访问期间取得的成果尚不清楚，而且几乎没有支持这一点的干预措施。使用音频记录 门诊访视是一种新的循证策略，具有支持三元互动的潜力，但其应用 在痴呆症中尚未被探索。本提案的目的是设计一种干预措施， 使用访问记录进行三方访问的通信。申请人将遵循NIH阶段模型重新设计他们的 访问记录平台HealthPAL，利用自然语言处理来构建访问信息。 具体目标是：目标1（阶段0）：进行前瞻性观察研究，门诊访视 200个三合会（PLWD/护理伙伴/临床医生）录音12个月; 1.a.检查之间的关联 三元AD/ADRD访视中的人际沟通和健康相关结局; 1.b.识别障碍， 三元AD/ADRD访视中人际沟通的推动因素;目标2（阶段1A）：调整HealthPAL， 加强三重AD/ADRD访视中的人际沟通;以及目标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。申请人假设： 1)人际沟通模型的构建将与健康相关的结果相关; 2） HealthPAL将超越二元组和临床医生的可用性、可行性和可接受性指标。目标1申请人 将使用解释性序贯混合方法设计。根据行为改变轮的信息， 行为变化将通过对三元组期间人际沟通的定量评估来确定。 访问（200对，每年3次访问; 10600次访问），辅以有目的的半结构化访谈 1a三联体样本（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、多中心初步试验（n = 30）， 确定HealthPAL的可用性、可行性和可接受性，并收集有关其对 AD/ADRD三元访视中的人际沟通。这项工作是改善PLWD的必要的第一步 通过识别影响人际沟通的行为及其与健康的关系， 相关成果。开发的干预措施和收集的大量数据将作为一个强大的 这是一种可用于解决与PLWD护理相关的临床知识方面的其他差距的资源。