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: 9099557
• 负责人: PHILIP D SLOANE
• 金额: $ 48.85万
• 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 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9099557
• 关键词: Accelerometer; Accident and Emergency department; Acute; Address; Adopted; Age; Agitation; Alzheimer' s Disease; Anxiety; Area; Behavioral; Behavioral Symptoms; Caregivers; Caring; Clinical Trials; Collaborations; Communication; Comorbidity; Consultations; Data; Decision Making; Dehydration; Dementia; Dementia caregivers; Development; Discipline of Nursing; Disease; Disease Progression; Education; Effectiveness; Emergency department visit; Evaluation; 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; Training Activity; Triage; Universities; Visit; base; cognitive testing; cost; decision-making capacity; design; eighth grade; evidence base; family support; field study; frailty; health literacy; health service use; implementation trial; improved; informal caregiver; medical attention; meetings; physical symptom; programs; protocol development; satisfaction; skills; symptom management; tool; web app

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）：大多数阿尔茨海默病（AD）患者与非正式（通常是家庭）护理人员一起生活在家中，这些护理人员必须评估，管理和与医疗保健提供者沟通医学症状（例如，疼痛和呼吸短促）和体征（例如，发热和躁动）。随着痴呆症的进展，对共病的易感性增加，沟通和决策能力降低，前往医疗机构的交通变得越来越困难。因此，非正式护理人员需要帮助他们评估，做出决定和管理可能代表新的或正在发展的医疗疾病的症状和体征的工具。 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学顾问（AlzMA），这是一个多组件工具包，将帮助AD患者的非正式护理人员识别，评估和管理新的或增加的疾病症状和体征，然后，如有必要，明确有效地将信息传达给医疗保健提供者。AlzMA将提供工具来评估各种可能的疾病，包括由随叫随到的护士进行审查和咨询，并以在线和印刷格式提供。我们的长期目标是让AlzMA接受临床试验测试，并被为AD患者服务的医疗实践和卫生系统广泛采用。 在项目的前2年，我们将通过一系列涉及我们的研究团队、临床顾问和非正式护理人员的步骤来开发、测试和完善工具包（目标1）。我们还将制定和完善一项衡量护理人员对评估和管理症状和体征能力的信心的措施（目标2）。在项目的第3年和第4年（目标3），我们将在200名由两种不同医疗实践管理的AD患者的不同护理人员中进行AlzMA工具包的实施试验。该试验将（a）在护理人员使用、获得的知识、护理人员和医疗实践工作人员的满意度以及有效性方面评估该工具包;（B）在基线、6个月和12个月时评估以下护理人员结果：管理痴呆症的自我效能、焦虑、症状和体征管理的信心、负担和抑郁;及（c）初步评估工具包使用前及使用期间的急症室求诊率及住院率。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。在第五年，我们将通过网络应用程序和DVD在全国范围内传播工具包的组成部分，并向医疗实践和卫生系统提供该系统（目标4）;此外，我们将完成对我们的研究成果的分析和传播。 该项目代表了来自查佩尔山的北卡罗来纳州大学、杜克家庭支持计划和基奥纳健康公司的团队的独特合作，基奥纳健康公司致力于在线协议和护士辅助分诊以及症状评估和管理的决策支持。