Utilizing the RESCUE Stroke Caregiver Website to Enhance Discharge Planning

利用 RESCUE 中风护理人员网站加强出院计划

• 批准号: 10181031
• 负责人: CONSTANCE R. UPHOLD
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2021-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181031
• 关键词: Activities of Daily Living; American Stroke Association; Caregiver Burden; Caregivers; Caring; Clinic Visits; Computerized Patient Records; Control Groups; Coupled; Data; Day Care; Decision Support Systems; Depth Perception; Discharge Plannings; Disease model; E-learning; Emergency department visit; Enrollment; Family member; Fees; Florida; Geriatrics; Goals; Health Care Costs; Health system; Healthcare Systems; Home; Institutionalization; Intervention; Interview; Lead; Length of Stay; Long-Term Care; Measures; Methods; Modeling; Nurses; Nursing Services; Office Nursing; Outcome; Patient Discharge; Patients; Perception; Persons; Phase; Policy Maker; Problem Solving; Process; Provider; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Recovery; Research; Research Assistant; Research Personnel; Role; Secure; Self Efficacy; Site; Stroke; Survivors; Technology; Telephone; Testing; Text; Time; Training; Translations; Travel; Validity and Reliability; Veterans; Veterans Hospitals; Visit; Work; attentional control; caregiver depression; caregiver education; caregiving; clinical practice; cost; depressive symptoms; encryption; evidence base; experience; firewall; follow-up; functional outcomes; group intervention; health care service utilization; health record; health related quality of life; high risk; hospital bed; hospital readmission; improved; instrument; intervention cost; intervention effect; novel; post stroke; programs; satisfaction; skills training; stroke intervention; stroke survivor; tool; treatment as usual; web site

DESCRIPTION (provided by applicant): Background: Caregiver depression is common following a family member's stroke and is a major contributor of survivor's hospital readmission and institutionalization. Researchers have consistently found that interventions to help caregivers resolve problems are effective in reducing depressive symptoms. However, these problem-solving interventions have been underused in practice because they involve multiple, in-person or telephone sessions and require large amounts of staff time to implement. To overcome these barriers, our long-term goal is to implement stroke caregiver programs that involve low-cost interventions that are sustainable in routine clinical practice. Our immediate objective is to test, using a randomized controlled trial, a problem-solving intervention for stroke caregivers that can be delivered during the Veterans' in-patient stays followed by online, in-home sessions. We will modify the traditional, problem-solving intervention by adding web-based training using interactive modules, factsheets, and tools on our previously developed and nationally available RESCUE Caregiver website (www.rorc.research.va.gov/rescue). We will also provide on-line, skills training and application of the problem-solving approach via the RESCUE messaging center, a secure site behind the VA firewall. This work builds on the team's extensive experience in stroke caregiver education. Our immediate, primary aim (#1) is to test the effect of the intervention on stroke caregivers' depressive symptoms at 14 weeks post-discharge from in-patient settings. Primary Hypothesis: Stroke caregivers who receive the intervention will have less depressive symptoms at 14 weeks compared to stroke caregivers in the attention control group. We propose four secondary aims. Aim #2 is to test the effect of the intervention on stroke caregivers' burden, problem-solving abilities, self-efficacy, health-related quality of life (HRQOL, and satisfaction with care at 14 weeks post-discharge. Aim #3 is to test the effect of the intervention on Veterans' outcomes: functional abilities and healthcare utilization (i.e., unintended hospital bed days of care, number of emergency room visits, number of unscheduled clinic visits) at 14 weeks post-discharge. Aim #4 is to determine the budgetary impact for implementing the intervention. Aim #5 is to determine the facilitators, barriers and best practices for implementing the intervention. Methods: We will conduct a two-group randomized controlled trial with repeated measures and use mixed methods to determine caregivers' perceptions of the intervention. We will enroll 240 stroke caregivers at 3 study sites (North Florida/South Georgia Veterans Healthcare System, Miami VA Healthcare System, and James A. Haley Veterans Hospital in Tampa) in VISN8. Eligible caregivers will be interviewed, complete baseline measures, and then be randomized to two groups: 1) intervention group, or 2) attention control group. A research assistant (RA) will telephone caregivers at 7 weeks and 14 weeks to answer questions on instruments with established reliability and validity. The RA will review the Veterans' VA Computerized Patient Record System health record to obtain information on the Veterans' healthcare utilization. We will determine the budgetary impact of the intervention by examining the cost data in the Decision Support System National Data Extracts and VA fee-basis files. Qualitative interviews will be conducted with selected caregivers to obtain in-depth perceptions of the value, facilitators, and barriers of the intervention. Throughout all phases of the project, we will collaborate with our VA (Offices of Nursing Service, Office of Geriatrics and Extended Care, My HealtheVet Program Office, Stroke QUERI Center) and non-VA partners (American Stroke Association). Impact: This is the first known study to test a discharge-planning intervention combined with technology to improve the quality of caregiving and the recovery of Veterans. Other outcomes will be a state-of-the-art website and an evidence-based model (in-patient, discharge planning and online, training and caregiver-provider messaging) that can be transportable to other disease models.

描述（由申请人提供）： 背景资料：照顾者抑郁症在家庭成员中风后很常见，是幸存者再次入院和机构化的主要原因。研究人员一直发现，帮助照顾者解决问题的干预措施在减少抑郁症状方面是有效的。然而，这些解决问题的干预措施在实践中没有得到充分利用，因为它们涉及多次面对面或电话会议，需要大量工作人员时间来实施。为了克服这些障碍，我们的长期目标是实施中风护理人员计划，包括在常规临床实践中可持续的低成本干预措施。我们的近期目标是使用随机对照试验来测试一种可以在治疗过程中为中风照顾者提供的解决问题的干预措施。 退伍军人的住院治疗，然后是在线的家庭会议。我们将修改传统的，解决问题的干预措施，通过增加基于网络的培训，使用交互式模块，概况介绍，和我们以前开发的全国可用的RESCUE护理网站上的工具（www.rorc.research.va.gov/rescue）。我们还将提供在线，技能培训和应用解决问题的方法，通过救援信息中心，一个安全的网站背后的VA防火墙。这项工作建立在团队在中风护理者教育方面的丰富经验之上。我们的直接、主要目的（1）是测试干预措施对住院患者出院后14周卒中照顾者抑郁症状的影响。主要假设：与注意力控制组的中风照顾者相比，接受干预的中风照顾者在14周时的抑郁症状较少。我们提出了四个次要目标。目的#2是测试干预对卒中照顾者负担、解决问题能力、自我效能、健康相关生活质量（HRQOL）和出院后14周对护理的满意度的影响。目标3是测试干预对退伍军人结果的影响：功能能力和医疗保健利用（即，出院后14周时的非预期医院病床护理天数、急诊室访视次数、计划外门诊访视次数）。目标4是确定实施干预措施的预算影响。目标5是确定实施干预措施的促进者、障碍和最佳做法。研究方法：我们将进行一项两组随机对照试验，重复测量，并使用混合方法来确定护理人员对干预的看法。我们将在3个研究中心（北佛罗里达/南格鲁吉亚退伍军人医疗保健系统、迈阿密退伍军人医疗保健系统和James A.坦帕的海利退伍军人医院）在VISN 8。合格的照顾者将接受访谈，完成基线测量，然后随机分为两组：1）干预组，或2）注意力控制组。研究助理（RA）将在7周和14周时致电护理人员，以回答具有既定可靠性和有效性的仪器上的问题。RA将审查退伍军人的VA计算机化患者记录系统健康记录，以获得退伍军人医疗保健利用的信息。我们将通过检查决策支持系统国家数据摘要和VA费用基础文件中的成本数据来确定干预措施的预算影响。将与选定的护理人员进行定性访谈，以深入了解干预的价值、促进因素和障碍。在整个项目的所有阶段，我们将与我们的VA（护理服务办公室，老年病和延伸护理办公室，我的HealtheVet计划办公室，中风QUERI中心）和非VA合作伙伴（美国中风协会）合作。影响：这是第一个已知的研究，以测试与技术相结合的出院计划干预，以提高退伍军人的康复质量。其他成果将是一个最先进的网站和一个基于证据的模型（住院，出院计划和在线，培训和供应商信息），可以移植到其他疾病模型。

项目成果

Effect of a telephone and web-based problem-solving intervention for stroke caregivers on stroke patient activities of daily living: A randomized controlled trial.

中风护理人员基于电话和网络的问题解决干预对中风患者日常生活活动的影响：一项随机对照试验。

• DOI: 10.1177/02692155231157301
• 发表时间: 2023
• 期刊: Clinical rehabilitation
• 影响因子: 3
• 作者: Quinn,EdwardB;LeLaurin,JenniferH;Eliazar-Macke,NathanielD;Orozco,Tatiana;Montague,Magda;Freytes,IMagaly;Uphold,ConstanceR
• 通讯作者: Uphold,ConstanceR