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Reducing disability following hospital discharge in vulnerable older adults: the CAPABLE intervention

减少弱势老年人出院后的残疾：CAPABLE 干预措施

基本信息

批准号：
9980253
负责人：
Sarah L Szanton
金额：
$ 62.42万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-01 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9980253
关键词：
Activities of Daily Living Acute Address Admission activity Adult African American Age Aging Area Attention Behavioral Caring Clinical effectiveness Data Development Discipline of Nursing Disease Education Effectiveness Effectiveness of Interventions Elderly Environment Equilibrium Ethnic Origin Europe Exercise Pain Management Face Female Floor Funding Gender Goals Grant Health Health Policy Hispanics Home Care Services Home Health Agency Home Nursing Care Home environment Hospitalization Hospitals Housing Impairment Individual Injury Inpatients Institution Intervention Interview Investigation Knowledge Latino Masks Mediation Medicaid Medicare Medicare/Medicaid Mental Depression Modeling Modification New York New York City New Zealand Nurses Nursing Homes Nursing Services Occupational Therapist Occupational Therapy Older Population Operative Surgical Procedures Pain Participant Pathway interactions Performance Persons Pharmaceutical Preparations Physical Function Policies Polypharmacy Population Population Heterogeneity Protocols documentation Public Health Quality of life Randomized Recovery Recovery of Function Rehabilitation therapy Reporting Reproducibility Research Assistant Residual state Risk Risk Factors Safety Science Self-Help Devices Services Skilled Nursing Facilities Social Policies Subgroup Testing Time Training Visit Visiting Nurse Vulnerable Populations aging in place aging population base care costs care providers cost depressive symptoms disability economic impact effectiveness testing eligible participant ethnic diversity evidence base falls follow-up functional decline health care service utilization improved improved functioning innovation intervention cost male modifiable risk novel novel strategies person centered pragmatic trial program costs programs racial diversity recruit repaired treatment as usual treatment group trial design

项目摘要

Two thirds of the 7 million older adults discharged from the hospital annually face new difficulty with activities of daily living (ADLs) that do not resolve by 12 months. To date there has been scant investigation of integrated health and housing interventions to improve physical function. Our proposed trial addresses this scientific gap. It builds upon results from our Center for Medicare and Medicaid Innovation Challenge grant. The older adults hospitalized in the previous year (N=78) who received the CAPABLE intervention, which combines evidence- based nursing, occupational therapy, and handyman components, reported difficulty with 41% fewer ADLs at 5 month follow-up than baseline. An improvement of this magnitude could make the difference between aging at home independently and needing institutional care. The proposed study will target this vulnerable group to provide new reproducible knowledge about improving physical function after skilled care using a rigorous pragmatic trial design. We propose to test the effectiveness of CAPABLE in older adults for whom recovery time and typical treatment were not sufficient to regain their functional ability. These individuals will be at least 60 days post-hospital discharge, have completed the skilled home health care allowed by Medicare, and still have difficulties with ADLs. We will recruit older (≥age 65), principally Latino and African American adults with ≥ 1 ADL difficulties from the Visiting Nurse Service of New York City Medicare Advantage population. We will interview participants at home and randomize them to either treatment (CAPABLE intervention) or control (usual care). Participants in the treatment group will receive up to 10 in-home sessions - ≤6 visits with an occupational therapist and ≤4 visits from a nurse – and ≤$1500 in safety and modification services from a licensed handyman. Each treatment participant will receive each intervention component (education, assessment, identification of functional goals, specific strategies tailored to goals and based on protocols). Participants in the usual care group will not receive grant related attention. All participants will be reassessed at 20 and 52 weeks by a research assistant masked to treatment condition. The primary aims of the study are to: 1) test the effectiveness of CAPABLE in reducing the number of ADLs performed with difficulty at 20 weeks post-randomization; and 2) estimate CAPABLE’s economic impact on subsequent health care utilization and costs over 1 year post-randomization compared to CAPABLE program cost. Our secondary aims include: 1) testing CAPABLE effectiveness on ADL function at 52 weeks; 2) testing effects for key subgroups (gender, ethnicity); and 3) examining theoretically-driven mediation pathways for treatment mechanisms. The proposed study would create new knowledge to improve function following hospitalization. Our approach responds to NIA’s strategic goals to understand disability and to improve the health of diverse older populations. Our approach also has timely policy relevance in promoting aging in place in an aging population.

每年从医院出院的700万老年人中有三分之二面临新的活动困难，日常生活能力（ADL）在12个月内未消退。到目前为止，对综合性的研究还很少。健康和住房干预措施，以改善身体机能。我们提出的试验解决了这一科学空白。它建立在我们的医疗保险和医疗补助创新挑战中心赠款的基础上。老年人在前一年住院（N=78），接受了CAPABLE干预，结合证据- 基础护理、职业治疗和勤杂工组成部分，报告5岁时ADL困难减少41% 随访时间比基线长。这种程度的改善可能会使年龄在独立在家，需要机构照顾。拟议的研究将针对这一弱势群体，提供新的可重复的知识，关于使用严格的务实的审判设计我们建议在老年人中测试CAPABLE的有效性，时间和典型治疗不足以恢复他们的功能能力。这些人至少出院后60天，已完成Medicare允许的熟练家庭医疗护理，在ADL方面有困难。我们将招募年龄较大（≥ 65岁）的患者，主要是拉丁美洲和非洲裔美国成年人，来自纽约市Medicare Advantage人群的访视护士服务的ADL困难≥ 1。我们将在家中采访参与者，并将他们随机分配到治疗组（CAPABLE干预组）或对照组（常规护理）。治疗组的受试者将接受最多10次家庭治疗- ≤6次访视，职业治疗师和≤4次护士访视-以及≤ 1500美元的安全和改造服务，有执照的勤杂工每名治疗参与者将接受每种干预成分（教育，评估、确定功能目标、针对目标并基于协议的具体策略）。普通护理组的参与者将不会得到与补助金有关的关注。所有参与者将重新评估在第20和52周时由研究助理对治疗条件设盲。研究的主要目的是目的：1）检测CAPABLE在减少20周时难以进行的ADL数量方面的有效性随机化后; 2）估计CAPABLE对后续医疗保健利用的经济影响，随机化后1年内的成本与CAPABLE项目成本相比。我们的次要目标包括：1）在52周时测试CAPABLE对ADL功能的有效性; 2）测试关键亚组（性别，种族）;和3）检查治疗机制的理论驱动的调解途径。拟议这项研究将创造新的知识，以改善住院后的功能。我们的方法响应于 NIA的战略目标是了解残疾并改善各种老年人口的健康状况。我们在促进人口老龄化中的就地养老方面，这一方法也具有及时的政策相关性。