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

约有100万痴呆症患者(PLWD)呆在家里，难以进入办公室- 以初级和专科护理为基础。他们经常不必要地使用急诊科和医院 导致不良的健康结果。基于家庭的初级保健(HBPC)将护理直接带到PLWD的家庭 并满足他们的需求。然而，它的广泛实施受到医生劳动力短缺的挑战。 护士从业者(NPs)在HBPC中的应用越来越多，是HBPC的主要提供者。关爱 待在家中的PLWD，NPS不仅提供直接护理，还领导HBPC团队并协调家庭-以及 以社区为基础的服务。NP-HBPC团队的结构各不相同，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还没有研究。我们将结合分析 NP-HBPC团队中的团队配置和社交网络，以及对NP员工结果的评估 确定团队最佳实践。我们将收集定性数据来评估潜在的团队合作动力，而不是 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。目的2.考察NP-HBPC团队组成与 社会网络与NP工作满意度、工作倦怠、离职倾向。目标3.确定障碍、促进者、 不同团队组成和社会网络的NP-HBPC团队的团队合作特征 关系。使用社交网络方法，我们将调查在纽约照顾PLWD的HBPC NPs(n=350人 州政府。我们将发送邮件调查，以及网络链接，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、工作倦怠和离职情况。数据将使用ORA*和R软件 分析。我们将映射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 测试团队和社交网络指标与NP结果之间的关系，以确定最佳团队 和网络结构，以获得有利的工作结果。在目标1的基础上，我们将从High-(n~20) 和(n~20)个连接不良的社交网络进行个人采访。对数据的内容分析将确定 主题。将对定量和定性结果进行三角划分，以便为利用NP-HBPC的努力提供信息。 工作人员照顾在家的PLWD和设计团队，以促进沟通和信息 转移，改善可持续发展妇女和照顾者的生活质量，并维持残疾人的福祉和功能 HBPC NP员工队伍。本申请是对特别关注通知的回应(非-AG-20-026)：痴呆症 为阿尔茨海默病和阿尔茨海默病相关痴呆症患者提供护理人员。

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.