Dissemination & Implementation Core

项目摘要 在过去的四十年里，许多非药物干预措施在试验中进行了测试（NIA I，II或III期） 已经证明了阿尔茨海默病（AD）或AD相关疾病患者的显著临床益处 痴呆（AD/ADRD; PWD）和家庭照顾者。然而，除了少数例外，经证实的干预措施既没有 在医疗机构（HCS）中使用嵌入式实用试验（ePCT）设计进行了测试， 传播。在HCS中缺乏务实的测试阻碍了将这种干预措施付诸实践， 家庭和医疗服务提供者对循证医学的了解和获取仍然有限， 在乎为了弥补这一关键差距，国家信息评估AD/ADRD的传播和执行核心（D & I） HCS合作实验室（合作实验室）将协助研究者和利益相关者（HCS，PWD，护理人员， 提供者，付款人）在实施和传播他们的痴呆症护理干预措施时， ePCT。本核心基于一个基本的科学假设：D & I考虑对于解决 在项目的整个生命周期（从概念构思、协议开发和测试到大规模 通过NIA阶段模型实施），以优化干预措施整合到HCS中的潜力。一 D & I核心计划的主要贡献将是推进和评估一个新框架的效用，以确定 进行ePCT干预的"准备"水平。D & I核心将由Laura N. Gitlin和Joseph Gaugler，并包括一个由五名国际公认的 痴呆症实施研究的专家。D & I Core的活动将与 由AD/ADRD合作实验室的利益相关者参与和多样性/包容性团队，HCS 领导理事会，以及试点、培训、设计/统计和监管/道德核心。具体 目标：目标1。进行、定期更新和传播关于以下方面的科学文献综述： 对残疾人和/或照顾者实施非药物干预;目标2：推进框架 确定试点研究的发展阶段及其开展ePCT的准备情况;以及目标3： 提供针对AD/ADRD合作资助的试点项目研究需求的持续技术援助 领导者和职业发展奖获得者，以及其他从一开始就进行ePCT的NIA资助的调查人员 项目发展的一个重要方面是使他们能够推进其实施和传播计划。影响： 在HCS中为PWD和照顾者广泛实施经证实的干预措施的持续失败 在很大程度上是由于不注意D & I科学从一开始干预的发展。 开展ePCT将需要系统地关注在以下方面开展研究的证据实践： 复杂，杂色的HCS。D & I Core是确保试点研究、CDA成功实施的关键 和ePCT，以提高临床相关性和改变痴呆症护理。

PROJECT SUMMARY Over the past four decades, a host of non-pharmacologic interventions tested in trials (NIA Stage I, II, or III) have demonstrated significant clinical benefits for people living with Alzheimer's disease (AD) or an AD-related dementia (AD/ADRD;PWD) and family caregivers. Yet, with few exceptions, proven interventions have neither been tested in health care settings (HCS) using embedded pragmatic trial (ePCTs) designs nor widely disseminated. The lack of pragmatic testing in HCS impedes the adoption of such interventions into practice, with families and health providers continuing to have limited knowledge of and access to evidence-based care. To address this critical gap, the Dissemination and Implementation Core (D&I) of the NIA AD/ADRD HCS Collaboratory (Collaboratory) will assist investigators, and stakeholders (HCS, PWD, caregivers, providers, payers) when implementing and disseminating their dementia care interventions in the context of ePCTs. This Core is based on a fundamental scientific assumption: D&I considerations are critical to address throughout a project’s life-cycle (from idea conception, protocol development and testing to wide scale implementation via the NIA Stage Model) to optimize an intervention’s potentiality for integration into HCS. A major contribution of the D&I Core will be to advance and evaluate the utility of a novel framework to ascertain level of “readiness” of an intervention to proceed to ePCTs. The D&I Core will be co-led by Drs. Laura N. Gitlin and Joseph Gaugler and include an Executive Committee (EC) of five internationally recognized experts in dementia implementation research. The D&I Core’s activities will be closely integrated with and informed by the AD/ADRD Collaboratory’s Stakeholder Engagement and Diversity/Inclusion Teams, HCS Leadership Council, and the Pilot, Training, Design/Statistics and Regulation/Ethics Cores. The Specific Aims are: Aim 1. Conduct, regularly update, and disseminate syntheses of the scientific literature regarding implementation of non-pharmacologic interventions for PWD and/or caregivers; Aim 2: Advance a framework for identifying stage of development of pilot studies and their readiness for conducting ePCT; and Aim 3: Provide ongoing technical assistance tailored to study needs of AD/ADRD Collaboratory-funded pilot project leaders and Career Development Awardees, and other NIA-funded investigators doing ePCTs from the outset of project development to enable them to advance their implementation and dissemination plans. IMPACT: The persistent failure of widespread implementation of proven interventions in HCS for PWD and caregivers is due in large part to inattention to D&I science from the inception of an intervention’s development. Conducting ePCTs will require systematic attention to evidentiary practices for implementing studies in complex, variegated HCS. The D&I Core is essential to assure implementation success of pilot studies, CDAs and ePCTs in order to enhance clinical relevance and change dementia care.