Utilizing the RESCUE Stroke Caregiver Website to Enhance Discharge Planning

描述(由申请人提供)： 背景：照顾者抑郁在家庭成员中风后很常见，是幸存者重新住院和住院的主要原因。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一直没有得到充分利用，因为它们涉及多次面对面或电话会议，并且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。我们的直接目标是使用随机对照试验测试一种针对中风护理者的解决问题的干预措施，该干预措施可以在 退伍军人的住院时间之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，在我们以前开发并在全国范围内提供的救援护理人员网站上增加基于网络的培训，使用互动模块、情况说明书和工具(www.rorc.research.va.gov/ue)。我们还将通过救援信息中心提供在线、技能培训和问题解决方法的应用，该中心是退伍军人事务部防火墙后的一个安全网站。这项工作建立在该团队在中风照顾者教育方面的丰富经验基础上。我们的直接、主要目标(#1)是测试干预措施对出院后14周中风照顾者抑郁症状的影响。基本假设：接受干预的中风照顾者在14周时比注意对照组的中风照顾者抑郁症状更少。我们提出了四个次要目标。目的二是测试干预对出院后14周卒中照顾者负担、问题解决能力、自我效能、健康相关生活质量(HRQOL)和护理满意度的影响。目的3是测试干预对退伍军人结果的影响：出院后14周的功能能力和医疗利用(即意外住院天数、急诊室就诊次数、计划外诊所就诊次数)。目标4是确定实施干预措施的预算影响。目标5是确定实施干预的促进者、障碍和最佳做法。方法：我们将进行重复测量的两组随机对照试验，并使用混合方法来确定照顾者对干预的感知。我们将在VISN8的3个研究地点(北佛罗里达州/南乔治亚州退伍军人医疗系统、迈阿密退伍军人医疗系统和坦帕的詹姆斯·A·黑利退伍军人医院)招募240名中风护理人员。符合条件的照顾者将接受访谈，完成基线测量，然后被随机分为两组：1)干预组，或2)注意对照组。研究助理(RA)将在7周和14周给照顾者打电话，回答有关具有既定可靠性和效度的工具的问题。RA将审查退伍军人退伍军人管理局计算机化患者记录系统的健康记录，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、国家数据摘录和退伍军人管理局收费档案中的费用数据来确定干预的预算影响。将与选定的照顾者进行定性访谈，以深入了解干预的价值、促进者和障碍。在项目的所有阶段，我们将与我们的VA(护理服务办公室、老年医学和长期护理办公室、My HealtheVet计划办公室、中风查询中心)和非VA合作伙伴(美国中风协会)合作。影响：这是已知的第一项测试出院计划干预与技术相结合的研究，以提高照顾质量和退伍军人的康复。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、培训和护理者-提供者消息传递)，可以移植到其他疾病模型。

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.