Home Based Primary Care for Persons Living with Dementia: Nurse Practitioner Teams and Outcomes

大约有100万痴呆症患者（PLWD）在家，难以进入办公室。 初级和专科护理。他们经常不必要地使用急诊室和医院， 导致健康状况不佳。以家庭为基础的初级保健（HBPC）将护理直接带到PLWD的家中 满足他们的需求。然而，其大规模实施受到医生劳动力短缺的挑战。 执业护士（NPs）越来越多地用于HBPC，是HBPC的主要提供者。照顾 对于在家的PLWD，NPs不仅提供直接护理，而且还领导HBPC团队并协调家庭- 社区服务。NP-HBPC团队结构各不相同，可能包括营养师，社会工作者， 药剂师、助手、心理健康提供者和其他人。到目前为止，人们对它的组成知之甚少。 高效的NP-HBPC团队。此外，团队成员如何沟通，分享建议，或帮助提供护理， PLWD或由此产生的社交网络如何影响结果尚未研究。我们将联合收割机分析 NP-HBPC团队中的团队配置和社交网络，并评估NP劳动力成果， 确定团队最佳实践。我们将收集定性数据，以评估潜在的团队合作动力， 定量捕获。具体目标是：目标1。确定NP的团队组成和社交网络- HBPC团队照顾PLWD。目标二。检查NP-HBPC团队组成与 社交网络与NP工作满意度、职业倦怠和离职倾向的关系。目标3：识别障碍、促进因素， 不同团队构成和社会网络的NP-HBPC团队的团队合作特征 连接.使用社会网络方法，我们将调查纽约的HBPC NPs（n=350）， 状态我们将发送邮件调查，沿着网络链接，要求NP确定他们的团队成员并报告 团队成员之间的联系（即，沟通，建议，信任，支持和解决问题）。 NPs还将报告他们的工作满意度，倦怠和营业额。ORA* 和R软件将用于数据 分析.我们将绘制团队配置和社交网络，将其可视化，并计算网络指标。 我们将使用二次分配程序来预测解释网络和回归模型的因素， 测试团队和社会网络测量与NP结果之间的关系，以确定最佳团队 和网络结构来获得有利的工作结果。基于目标1，我们将从高-（n~20） 和连接不良的社交网络（n~20）进行个体访谈。数据的内容分析将确定 主题.将对定量和定性调查结果进行三角分析，为利用NP-HBPC的工作提供信息 护理居家残疾人的劳动力和促进沟通和信息的设计团队 转移，改善PLWD和照顾者的生活质量，并维持 HBPC NP员工。本申请是对特别关注通知（NOT-AG-20-026）的回应：痴呆症 老年痴呆症和老年痴呆症相关痴呆症患者的护理工作人员。

About one million Persons Living With Dementia (PLWD) are homebound and have difficulty accessing office‐ based primary and specialty care. They often unnecessarily use emergency departments and hospitals which result in poor health outcomes. Home based primary care (HBPC) brings care directly to the homes of PLWD’s and meets their needs. Yet, its wide-scale implementation is challenged by physician workforce shortages. Nurse practitioners (NPs) are increasingly utilized in HBPC and are the dominant HBPC provider. To care for homebound PLWD, NPs not only deliver direct care but also lead the HBPC team and coordinate home- and community-based services. NP-HBPC teams structures vary and may include dieticians, social workers, pharmacists, aides, mental health providers, and others. To date little is known about the composition of effective NP-HBPC teams. Also, how team members communicate, share advice, or help to deliver care to PLWD or how the resulting social networks affect outcomes have not been studied. We will combine analysis of team configurations and social networks in NP-HBPC teams with assessment of NP workforce outcomes to identify team best practices. We will collect qualitative data to assess the underlying teamwork dynamics not captured quantitatively. The specific aims are: Aim 1. Identify team composition and social networks of NP- HBPC teams caring for PLWD. Aim 2. Examine the relationship between NP-HBPC team composition and social networks and NP job satisfaction, burnout, and turnover intention. Aim 3. Identify barriers, facilitators, and characteristics of teamwork in NP-HBPC teams with different team compositions and social network connections. Using social network methods, we will survey HBPC NPs (n=350) caring for PLWD in New York state. We will send mail surveys, along with web links, to ask NPs to identify their team members and report the connections between team members (i.e., communication, advice, trust, support, and problem-solving). NPs will also report on their job satisfaction, burnout, and turnover. ORA* and R software will be used for data analysis. We will map team configurations and social networks, visualize them, and compute network metrics. We will use Quadratic Assignment Procedure to predict factors explaining networks and regression models to test the relationships between team and social network measures and NP outcomes to identify the best team and network structures for favorable job outcomes. Based on Aim 1, we will recruit NPs from highly- (n~20) and poorly- (n~20) connected social networks for individual interviews. Content analysis of the data will identify themes. Quantitative and qualitative findings will be triangulated to inform efforts to leverage the NP-HBPC workforce to care for homebound PLWD and design teams to facilitate communication and information transfer, improve the quality of life for PLWD and caregivers, and maintain the wellbeing and functioning of the HBPC NP workforce. This application is in response to Notice of Special Interest (NOT-AG-20-026): Dementia Care Workforce for Those Living with Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias.