Helping Invested Families Improve Veterans Experiences Study (HI-FIVES)

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：为功能受损退伍军人的非正式护理人员设计和实施培训计划，HI-FIVES将提高护理人员的技能，从而提高退伍军人医疗保健质量，退伍军人留在家中的能力以及对VHA护理的满意度。 项目背景：紧张，负担和倦怠是非常普遍的照顾者，往往与照顾者抑郁症或增加的风险机构的照顾者。 我们建议评估一个创新的计划，培训非正式的照顾者时，退伍军人被称为VHA家庭和社区为基础的护理（HCBC），在退伍军人的VHA医疗保健使用的关键时刻。 转介到HCBC是一个时间，照顾者可能会面临个人的压力和不确定性的要求涉及的照顾。 因此，它提供了一个可教的时刻，以培训照顾者，以更好地满足所提出的要求。 项目目标：为了评估在12个月内，与接受常规护理的退伍军人相比，在技能培训计划中有护理人员的退伍军人在家中度过的天数是否有临床显著增加（例如，不在急诊室、医院或疗养院的天数）;显著降低VA医疗护理成本，并提高对VHA的满意度。 最后，我们将评估HI-FIVES中的照顾者与常规护理中的照顾者相比，干预后抑郁症状是否有临床显著减少。 项目方法：该研究是一项随机对照试验，在训练前后以及项目完成后12个月收集了患者-患者配对的数据。 背景是达勒姆VAMC。 患者入选标准是过去3个月内转诊至HCBC的患者，不符合临终关怀条件，居住在家中，有非正式护理人员，愿意参与并愿意让我们联系护理人员。 护理人员必须是成年人，能够参与，懂英语，未接受过药物滥用障碍治疗，未参与另一项干预性研究，并愿意参与。 对照组的护理人员将接受通常由HCBC提供的培训和支持。 退伍军人将有至少2个日常生活活动的限制，并有可能有多morphism，包括认知障碍的高利率。 每组的目标样本量为103个双配对，患者参与仅限于4次简短的电话评估。 治疗组的护理人员将参加三次电话培训电话和四次小组会议，两组护理人员将被要求提供四次电话评估。 将使用描述性统计量总结所有研究变量。 最重要的是检查干预后12个月期间患者不在家的天数分布。 我们将使用最适合我们数据的计数数据回归模型（泊松，负二项或零膨胀版本）来检验主要假设，即HI-FIVES中有护理人员的退伍军人将比常规护理的退伍军人有更多的在家天数。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Designing and implementing a training program for informal caregivers of functionally impaired Veterans, HI-FIVES will improve the skill of caregivers, thereby improving Veteran health care quality, the ability for Veterans to remain at home, and satisfaction with VHA care. Project Background: Strain, burden and burnout are highly prevalent in caregivers, and are often associated with caregiver depression or increased risk of institutionalization of the care recipient. We propose to evaluate an innovative program that trains informal caregivers when Veterans are referred to VHA home and community-based care (HCBC), a critical moment in a Veteran's VHA health care use. Referral to HCBC is a time that caregivers may face personal strain and uncertainty about demands involved in caregiving. As such, it presents a teachable moment to train caregivers to better meet the demands imposed by caregiving. Project Objectives: To evaluate whether over 12 months, Veterans with caregivers in the skill training program have clinically significant increases in days spent at home compared to Veterans in usual care (e.g., days not in emergency department, hospital, or nursing home); significantly lower VA costs of medical care, and higher satisfaction with VHA. Finally, we will evaluate whether caregivers in HI-FIVES have clinically significant reductions in depressive symptoms post-intervention compared to caregivers in usual care. Project Methods: The study is a randomized controlled trial with data collection from caregiver-patient dyads before and after training, and at 12 months after program completion. The setting is the Durham VAMC. Patient inclusion criteria are patient referred to HCBC in the past 3 months, not eligible for hospice, residing at home, has an informal caregiver, willing to participate and willig to let us contact the caregiver. Caregivers must be adults, capable to participate, understand English, not be treated for a substance abuse disorder, not be in another interventional study, and willing to participate. Caregivers in the control group will receive the training and support usually provided by HCBC. Veterans will have a minimum of 2 activities of daily living limitations, and are likely to have multimorbidity, including high rates of cognitive impairment. The target sample size will be 103 caregiver-dyads in each arm. Patient involvement will be limited to four short phone assessments. Caregivers in the treatment arm will take part in three phone training calls and four group sessions, and in both arms caregivers will be asked to provide four phone assessments. Descriptive statistics will be used to summarize all study variables. Of primary importance will be to examine the distribution of patient days not at home during the 12 months of the post-intervention period. We will use the count-data regression model which best fits our data (Poisson, Negative Binomial or zero-inflated versions of these) to test the primary hypothesis that Veterans with caregivers in HI-FIVES will have significantly more days at home than Veterans in usual care.