Supporting Family Caregivers with Technology for Dementia Home Care (FamTechCare)

描述（由申请人提供）：该临床试验将测试 FamTechCare 干预措施，该干预措施使用基于家庭视频监控的多学科专业指导来支持家庭护理人员管理痴呆症患者 (PWD) 的行为。家庭为残疾人提供大部分在家护理。然而，护理压力如此之大，以至于增加了护理人员的发病率和死亡率。破坏性行为会加剧压力，这些行为常常导致被安置在疗养院。家庭视频监控使专家能够评估残疾人的行为并识别前因，推荐具体的干预措施，并随后评估护理人员的结果。 FamTechCare 使用新技术将家庭护理人员与专家联系起来，以获得管理破坏性行为的指导，支持家庭持续护理，同时减少护理的负面影响。 来自爱荷华大学医院和诊所以及堪萨斯大学阿尔茨海默病中心的护理人员-残疾人二人组 (N=88) 将被随机分配到干预组或对照组。两组人员将使用家庭监控装置记录 3 个月日常护理期间的行为。值得注意的是，这项新技术捕捉行为发生前 15 分钟，从而记录行为触发因素和前兆。干预小组视频将自动上传到 HIPAA 安全互联网网站，以便每周进行团队审查，并向护理人员提供行为管理方面的家庭反馈。时间和注意力相当的对照组将每周接到护士的电话，但他们录制的视频将在 3 个月后保存以供审查和反馈。这项研究以 PI 的 CTSA 研究为基础，该研究验证了使用家庭监测和专业行为观察来指导护理人员管理家庭护理的可行性。我们的团队发现视频数据对于识别前因、推荐具体干预措施以及随后评估反应至关重要。护理人员对破坏性行为以及自身压力和负担的减少感到非常满意。 这项研究扩展了 IRB 批准的协议、程序、HIPAA 安全软件界面以及基于互联网的团队会议和护理人员反馈的协议。研究目的是根据家庭观察确定干预措施，以协助护理人员进行行为管理。将使用线性混合模型比较组间对结果的影响，包括残疾人破坏性行为和护理人员负担以及其他负面结果。我们将评估易用性和满意度、成本效益以及影响转化为实践的可能性的因素。这是第一项测试新技术的研究，用于直接观察和即时反馈，使家庭能够在家中管理残疾人行为，同时减少护理人员的压力和发病率。技术将护理人员与个性化的专家指导联系起来，承认他们角色的重要性和负担。这项研究涉及 NIH 的使命和 2012 年解决阿尔茨海默病国家计划的目标，整合了促进在干预措施中采用和使用老龄化服务技术的策略，以减少护理人员的负面结果（这一日益严重的公共卫生问题）。

DESCRIPTION (provided by applicant): This clinical trial will test the FamTechCare intervention that uses multidisciplinary professional guidance based on in-home video monitoring to support family caregivers in managing behaviors of persons with dementia (PWD). Families provide the majority of care for PWD at home. However the stress of caregiving is so significant that it increases caregiver morbidity and mortality. Stress is magnified by disruptive behaviors that frequently lead to nursing home placement. In-home video monitoring allows experts to assess behaviors of PWD and to identify antecedents, recommend specific interventions, and subsequently evaluate caregiver outcomes. FamTechCare uses new technology to link family caregivers to experts for guidance in managing disruptive behaviors, supporting continued care at home while reducing the negative effects of caregiving. Caregiver-PWD dyads (N=88) from the University of Iowa Hospital and Clinics and the University of Kansas Alzheimer's Disease Center will be randomly assigned to intervention or control groups. Both groups will record behaviors during daily care for 3 months using a home monitoring unit. Notably, this new technology captures 15 minutes prior to the behavior, thus recording behavior triggers and precursors. Intervention group videos will be auto-uploaded to a HIPAA-secure Internet site for weekly team review with in-home feedback to caregivers in behavior management. The time and attention equivalent control group will receive a weekly phone call from a nurse, but their recorded videos will be held for review and feedback after 3 months. This study builds on the PI's CTSA study that verified feasibility for using in-home monitoring and professional observation of behaviors to guide caregivers in managing care at home. Our team found the video-data essential to identify antecedents, recommend specific interventions, and subsequently evaluate responses. Caregivers were highly satisfied with reductions in disruptive behaviors and their own stress and burden. This study expands the IRB-approved protocols, procedures, HIPAA-secure software interface, and protocols for internet-based team meetings and caregiver feedback. Study aims are to identify interventions, based on in-home observations, to assist caregivers in behavior management. Between-group effects on outcomes, including PWD disruptive behaviors and caregiver burden and other negative outcomes will be compared using linear mixed modeling. We will evaluate ease of use and satisfaction, cost-efficiency, and factors influencing likelihood of translation into practice. Thi is the first study to test new technology for direct observation and immediate feedback to empower families to manage PWD behaviors at home while reducing caregiver stress and morbidity. Technology links caregivers to individualized expert guidance, acknowledging the importance and burden of their role. This study addresses NIH missions and the 2012 National Plan to Address Alzheimer's disease goals, integrating strategies to promote adoption and use of aging services technologies in interventions that will reduce negative caregiver outcomes, a growing public health problem.