Tools for Distance Delivery of an Evidence-based AD Family Caregiver Intervention

基于证据的 AD 家庭护理人员干预的远程交付工具

• 批准号: 8394891
• 负责人: John V Hobday
• 金额: $ 39.41万
• 依托单位: HEALTHCARE INTERACTIVE, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-15 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8394891
• 关键词: Address; Age; Aging; Alzheimer' s Disease; Americas; Area; Caregivers; Caring; Communities; Confidentiality; Control Groups; Counseling; Country; Coupled; Data; Data Analyses; Dementia; Discipline; Disease; Disease Management; Effectiveness; Elderly; Emotional; Enrollment; Ensure; Evidence based intervention; Family; Family Caregiver; Family member; Feedback; Focus Groups; Funding; Geographic Locations; Healthcare; Healthcare Systems; Home environment; Internet; Intervention; Knowledge; Language; Left; Life; Link; Literature; Mental Depression; Modeling; New York; Nursing Homes; Participant; Persons; Phase; Play; Population; Population Heterogeneity; Problem behavior; Professional counselor; Provider; Public Health; Randomized Controlled Trials; Reaction; Recruitment Activity; Reporting; Research; Research Personnel; Reservations; Resources; Role; Rural; Schedule; Secure; Security; Services; Site; Social Work; Social support; Spouse Caregiver; Surveys; System; Technology; Telephone; Testing; Time; TimeLine; Training; Travel; United States Centers for Medicare and Medicaid Services; Universities; Veterans; Videoconferences; Videoconferencing; Writing; base; caregiving; cost; cost effective; depressive symptoms; design; evidence base; experience; health care delivery; improved; innovation; innovative technologies; member; patient home care; physical conditioning; prevent; programs; prototype; psychologic; psychosocial; satisfaction; skills; telehealth; tool

DESCRIPTION (provided by applicant): As the US population ages, Alzheimer's disease and related disorders (ADRD) will present an emotional and financial burden to an increasing number of families and the U.S. healthcare system. More than 75% of the care for persons with ADRD is provided by family members at home, who need ongoing support to manage the daunting physical and psychological demands of care. A 20+ year randomized controlled trial (RCT) demonstrated the many benefits of a counseling and support intervention for spouse caregivers, the NYU Caregiver Intervention (NYUCI). Most notably, the NYUCI substantially reduced caregiver's depressive symptoms, improved their physical health, and extended the time persons with ADRD remained at home by an average of 1.5 years (Mittelman et al., AG14634, formerly MH42216; See www.nrepp.samhsa.gov/programfulldetails.asp? PROGRAM_ID=122). The intervention is now being widely implemented, but there are barriers that prevent many caregivers from receiving its benefits, including geographic distance; impediments to older adults leaving their homes; and travel considerations for counselors which make it impossible to provide the NYUCI. This innovative Fast Track application has massive implications for social service delivery to older adults, because it will make it possible to delivr an in-person intervention which is already evidenced based to older adult caregivers who cannot currently be served. It will create the online reservation and management technology linking counselors with families as well as the evidence of effectiveness of providing such services via secure video teleconferencing vehicles. The proposed Telehealth Technology for Distance Counseling (TTDC) and related online educational training modules will connect skilled providers to the families of persons with dementia without regard to geographic location. Implications for rural healthcare delivery are particularly persuasive. To our knowledge, this will be the first large-scale TTDC to be developed and rigorously tested with a randomized controlled trial. We hypothesize that such a system, coupled with online training for providers and families on tele- counseling and distance caregiving, will have similar benefits to those achieved with in-person counseling during the original NYUCI RCT. The TTDC will include a scheduling system to link counselors to families at their mutual convenience and assure delivery in a cost-effective manner. The TTDC has the additional potential to transform ADRD care in ethnic and culturally diverse communities by connecting highly trained NYUCI counselors with specialized language and cultural skills to families who would not have access to these resources locally. This innovative technology has strong commercial potential not only for providing effective and efficient supportive services to rural and ethnically diverse populations, but also for a variety of other disease management areas. PUBLIC HEALTH RELEVANCE: This Fast Track effort develops and evaluates a Telehealth Technology for Distance Counseling (TTDC) and online educational training modules for the national tele-delivery of the evidence-based New York University Caregiver Intervention (NYUCI) model, a psychosocial intervention for families of those with Alzheimer's disease (AD). This effort is highly relevant to U.S. public health because the NYUCI has been shown to reduce depression in caregivers and delay nursing home placement by 1.5 years, on average, but is not widely available, particularly in rural America. Widespread tele-delivery of the NYUCI model made possible by the proposed TTDC and training could support increasing numbers of the 10.9 million family caregivers delivering nearly 75% of the home care for those with AD (Alzheimer's Association: 2010 Alzheimer's Disease Facts and Figures) and provide the evidence necessary to support the argument for agencies such as the Centers for Medicare and Medicaid Services (CMS) to allow billable counseling sessions over secure video teleconferencing vehicles.

描述（由申请人提供）：随着美国人口老龄化，阿尔茨海默病和相关疾病（ADRD）将给越来越多的家庭和美国医疗保健系统带来情感和经济负担。超过75%的ADRD患者的护理是由家庭成员在家中提供的，他们需要持续的支持来管理令人生畏的身体和心理护理需求。一项为期20多年的随机对照试验（RCT）证明了为配偶照顾者提供咨询和支持干预的许多好处，即纽约大学照顾者干预（NYUCI）。最值得注意的是，NYUCI大大减少了照顾者的抑郁症状，改善了他们的身体健康，并将ADRD患者留在家中的时间平均延长了1.5年（Mittelman等人，AG 14634，以前称为MH 42216;见www.nrepp.samhsa.gov/programfulldetails.asp? ID=122）。干预措施现在正在广泛实施，但有障碍，阻止许多照顾者获得其好处，包括地理距离;老年人离开家园的障碍;以及顾问的旅行考虑，使其无法提供NYUCI。这种创新的快速通道应用程序对向老年人提供社会服务具有巨大的影响，因为它将使提供面对面的干预成为可能，这已经证明了目前无法获得服务的老年人照顾者。它将创建在线预订和管理技术，将咨询师与家庭联系起来，并通过安全的视频电话会议工具提供有效的服务。拟议的远程咨询远程保健技术和相关的在线教育培训模块将使熟练的提供者与痴呆症患者的家庭联系起来，而不考虑地理位置。对农村医疗服务的影响特别有说服力。据我们所知，这将 成为第一个大规模的TTDC开发和严格测试的随机对照试验。我们假设，这样一个系统，再加上在线培训的提供者和家庭的远程咨询和远程咨询，将有类似的好处，在原来的NYUCI随机对照试验期间与面对面的咨询。TTDC将包括一个时间安排系统，以便在相互方便的情况下将顾问与家庭联系起来，并确保以具有成本效益的方式提供服务。TTDC具有额外的潜力，通过将训练有素的NYUCI顾问与专业语言和文化技能联系起来，改变种族和文化多样性社区的ADRD护理，以帮助那些无法获得这些资源的家庭。这项创新技术具有强大的商业潜力，不仅可以为农村和不同种族的人口提供有效和高效的支持服务，而且还可以用于其他各种疾病管理领域。 公共卫生相关性：这项快速通道工作开发和评估了远程咨询远程保健技术（TTDC）和在线教育培训模块，用于全国远程提供基于证据的纽约大学护理人员干预（NYUCI）模型，这是一种针对阿尔茨海默病（AD）患者家庭的心理社会干预。这一努力与美国公共卫生高度相关，因为NYUCI已被证明可以减少护理人员的抑郁症，并将养老院安置时间平均推迟1.5年，但并不广泛，特别是在美国农村。拟议的TTDC和培训使NYUCI模式的广泛远程交付成为可能，可以支持越来越多的1090万家庭护理人员为AD患者提供近75%的家庭护理（Alzheimer's Association）：2010年阿尔茨海默病的事实和数字），并提供必要的证据，以支持论点的机构，如医疗保险和医疗补助服务中心（CMS）允许通过安全的视频电话会议车辆进行收费的咨询会议。