Alzheimers Medical Advisor: A Symptom and Sign Management Toolkit for Caregivers

阿尔茨海默病医疗顾问：针对护理人员的症状和体征管理工具包

• 批准号: 8690627
• 负责人: PHILIP D SLOANE
• 金额: $ 50.05万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-27 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8690627
• 关键词: Accident and Emergency department; Acute; Address; Adopted; Age; Agitation; Alzheimer' s Disease; Anxiety; Area; Behavioral; Behavioral Symptoms; Caregivers; Caring; Clinical Trials; Cognitive; Collaborations; Communication; Comorbidity; Consultations; Data; Decision Making; Dehydration; Dementia; Development; Discipline of Nursing; Disease; Disease Progression; Education; Effectiveness; Evaluation; Family; Family Caregiver; Family member; Fever; Focus Groups; Goals; Health; Health Personnel; Health Professional; Health system; Home environment; Hospital Departments; Hospitalization; Internet; Intervention; Knowledge; Life; Literature; Measures; Medical; Mental Depression; Modification; Monitor; North Carolina; Nurses; Nursing Protocols; Outcome; Pain; Pain Measurement; Participant; Persons; Predisposition; Primary Health Care; Printing; Protocols documentation; Provider; Proxy; Psychometrics; Race; Reading; Recommendation; Reporting; Research; Resources; Rest; Self Efficacy; Series; Services; Shortness of Breath; Signs and Symptoms; Site; Symptoms; System; Techniques; Testing; Time; Training; Triage; Universities; Visit; base; cost; decision-making capacity; design; eighth grade; evidence base; frailty; health care service utilization; health literacy; implementation trial; improved; medical attention; meetings; programs; protocol development; satisfaction; skills; symptom management; tool

DESCRIPTION (provided by applicant): Most persons with Alzheimer's disease (AD) live at home with informal (usually family) caregivers who must evaluate, manage, and communicate with health care providers about medical symptoms (e.g., pain and shortness of breath) and signs (e.g., fever and agitation). As dementia progresses, susceptibility to comorbid illness increases, communication and decision-making capacity are reduced, and transport to medical facilities becomes increasingly difficult. As a result, informal caregivers need tools that will hep them evaluate, make decisions about, and manage symptoms and signs that could represent new or evolving medical illness. The proposed project will develop, field test, refine, evaluate, finalize, and disseminate the Alzheimer's Medical Advisor (AlzMA), a multi-component toolkit that will assist informal caregivers of persons with AD to identify, evaluate, and manage new or increasing symptoms and signs of illness and then, if necessary, clearly and effectively communicate the information to health care providers. AlzMA will provide tools to evaluate a wide range of possible illnesses, include review and consultation by an on-call nurse, and be available in online and printed formats. Our long-term goal is for the AlzMA to undergo clinical trial testing and be adopted widely by medical practices and health systems serving persons with AD. During the first 2 years of the project we will develop, test, and refine the toolkit through a series of steps involving our research team, consultant clinicians, and informal caregivers (Aim 1). We will also develop and refine a measure of caregiver confidence in the ability to assess and manage symptoms and signs (Aim 2). During years 3 and 4 of the project (Aim 3) we will conduct an implementation trial of the AlzMA toolkit among 200 diverse caregivers of persons with AD who are managed by two diverse medical practices. The trial will (a) evaluate the toolkit in terms of caregiver use, knowledge gained, satisfaction of caregivers and medical practice staff, and effectiveness; (b) evaluate the following caregiver outcomes at baseline, 6 and 12 months: self-efficacy in managing dementia, anxiety, confidence in symptom and sign management, burden, and depression; and (c) on a preliminary basis, evaluate emergency department visit and hospitalization rates before and during toolkit use. Analyses will evaluate the impact of caregiver factors and toolkit format on the above outcomes. During year 5 we will disseminate components of the toolkit nationally through a web application and DVD, and make the system available to medical practices and health systems (Aim 4); in addition, we will complete the analysis and dissemination of our research results. This project represents a unique collaboration of teams from the University of North Carolina at Chapel Hill; the Duke Family Support Program; and Keona Health, a company devoted to online protocol and nurse- assisted triage and decision support on symptom evaluation and management.

描述（由申请人提供）：大多数患有阿尔茨海默氏病（AD）的人与非正式的（通常是家庭）的护理人员一起生活，他们必须与医疗保健提供者有关医疗症状（例如疼痛和呼吸疼痛）和迹象（例如发烧和煽动）进行评估，管理和沟通。随着痴呆症的进展，对合并症的易感性增加，沟通和决策能力降低，运输到医疗设施变得越来越困难。结果，非正式的护理人员需要将其评估，决定并管理可能代表新的或不断发展的医学疾病的症状和迹象的工具。 拟议的项目将开发，现场测试，完善，评估，最终确定和传播阿尔茨海默氏症医疗顾问（ALZMA），这是一种多组分工具包，该工具包将有助于有助于AD的人的非正式护理人员，以识别，评估，评估和管理新的或增加疾病的症状或增加疾病，然后清楚地，有效地进行医疗保健服务，以确保疾病的症状和迹象。 Alzma将提供评估各种可能疾病的工具，包括待命护士的审查和咨询，并以在线和印刷格式提供。我们的长期目标是使Alzma接受临床试验测试，并被为AD人员服务的医疗实践和卫生系统广泛采用。 在该项目的前两年中，我们将通过一系列涉及我们的研究团队，顾问临床医生和非正式护理人员的步骤来开发，测试和完善工具包（AIM 1）。我们还将开发和完善对评估和管理症状和体征能力的护理人员信心的度量（AIM 2）。在该项目的第3和4年度（AIM 3）中，我们将在200名由AD的不同医疗惯例管理的AD的不同护理人员中进行ALZMA工具包的实施试验。该试验将（a）评估工具包，从照顾者使用，获得的知识，护理人员和医疗实践人员的满意度以及有效性评估工具包； （b）评估基线，6和12个月的以下护理人员的结果：管理痴呆症，焦虑，对症状和标志管理的信心，负担和抑郁的自我效能； （c）在初步的基础上，在使用工具包之前和期间评估急诊科的访问和住院率。分析将评估护理人员因素和工具包格式对上述结果的影响。在第5年期间，我们将通过Web应用程序和DVD在全国范围内传播该工具包的组件，并使该系统可用于医疗实践和卫生系统（AIM 4）；此外，我们将完成研究结果的分析和传播。 该项目代表了北卡罗来纳大学教堂山分校的团队的独特合作；杜克家庭支持计划；和Keona Health是一家致力于在线协议的公司，并在症状评估和管理方面提供了护士协助分类和决策支持。