PREP--FAMILY BASED CARE FOR FRAIL OLDER PERSONS

家庭护理研究是一项PREP的随机对照疗效试验，是一项家庭健康干预措施，旨在提高对体弱老年人家庭护理的准备、充实和可预测性。PREP以家庭为重点，由三个部分组成：(1)家庭与护士共同解决家庭护理问题；(2)24小时PREP咨询热线；(3)护士使用Keep-in-Touch进行随访。简要的主要目标（完整目标见第98页）是：(1)描述PREP家庭所确定的护理，为解决这些问题而实施的策略，以及策略的有效性；(2)确定与扩展家庭健康（EHH）和标准家庭健康（SHH）相比，PREP是否显著改善了家庭护理变量（如照顾者[CG]技能、CG角色压力等）和健康状况，包括照顾者（CR）功能；(3)确定PREP在黑人与白人、低收入与中等收入家庭中的效果是否存在差异；(4)确定与SHH相比，EHH是否对家庭护理变量和健康有有益影响；(5)确定PREP和EHH对家庭护理变量和健康的影响是否在干预退出后继续存在。拟议的研究还将涉及两个次要目标，即衡量PREP、EHH和SHH中cr和CGs的正式和非正式卫生保健服务的使用和成本。该研究将采用三组设计。样本将包括360名老年人，他们符合医疗保险标准，在一家大型非营利HMO进行熟练的家庭护理。至少60个黑人家庭和60个低收入白人家庭将被纳入样本。所有样本将随机分为PREP、EHH或SHH组。准备工作将由准备工作护士在一个跨学科团队的背景下向家庭提供为期12个月的准备工作。在EHH中，与PREP团队组成相当的家庭健康时间将被给予与PREP团队相同的资源，PREP团队将被给予与PREP相同的资源来提供护理，但不会使用PREP的目标和原则。SHH将是HMO提供的通常的家庭医疗保健。研究将使用六种研究方法和数据来源：家庭护理清单、家庭护理质量量表、家庭健康日记、KPNW家庭健康自动化临床信息系统（DOCPLUSR）、KPNW自动化数据系统和家庭费用日历。将获得研究开始前12个月和研究开始后20个月的利用率和成本数据。分析将包括回归分析、生存分析和重复测量方差分析。

The Family Care Study is a randomized controlled efficacy trial of PREP, and a home health intervention designed to increased Preparedness Enrichment, and Predictability in family care for frail elders. PREP is distinguished by its family focus and has three parts: (1) the family and nurse working together of family care issues, (2) 24-hour PREP Advice Line; and (3) follow-up contact by the nurse using Keep-in-Touch. The abbreviated primary aims (full aims on page 98) are to: (1) describe the care issued identified by PREP families, the strategies implemented to resolve these issues, and the effectiveness of the strategies; (2) determine whether compared to Extended Home Health (EHH) and Standard Home Health (SHH), PREP significantly improves family care variables (e.g., caregiver [CG] skill, CG role strain etc.) And health status, including care receiver (CR) function; (3) determine whether PREP is differentially effective in Black versus White and in low versus middle income families; (4) determine whether EHH, compared to SHH, has beneficial effects on family care variables and health; and (5) determine whether any effects of PREP and EHH on family care variables and health continue after the intervention is withdrawn. The proposed study will also address two secondary aims related to measuring use and cost of formal and informal health care services for CRs and CGs in PREP, EHH, and SHH. The study will use a 3-group design. The sample will include 360 older people who meet Medicare criteria for skilled home care at a large not-for- profit HMO. At least 60 Black and 60 low-income White families will be included in the sample. All samples will be randomized to PREP, EHH, or SHH. PREP will be delivered to families by PREP nurses within the context of an interdisciplinary team for a period of 12 months. In EHH, a home health time comparable in composition to the PREP team will be given the same resources as PREP team will be given the same resources as PREP to deliver care but will not use the goals and principles of PREP. SHH will be the usual home health care provided by the HMO. Six research measures and data sources will be used: The Family Care Inventory, Quality of Family Care Scale, Family Health Diary, KPNW Home Health automated clinical information system (DOCPLUSR), KPNW automated data systems, and the Family Expense Calendar. Utilization and cost data will be obtained for 12 months prior to and 20 months after study entry. Analyses will include regression, survival analysis, and repeated measures ANOVA.