Dissemination & Implementation Core

项目总结 在过去的40年里，许多非药物干预措施在试验中进行了测试(NIA阶段I、II或III) 已证明对阿尔茨海默病(AD)患者或AD相关患者有显著的临床益处 痴呆症(AD/ADRD；PWD)和家庭照顾者。然而，除了极少数例外，经过验证的干预措施既没有 在使用嵌入式实用试验(EPCTS)设计的医疗保健环境(HCS)中进行了测试，但未广泛使用 散播的。HCS中缺乏实用测试阻碍了将这种干预措施付诸实践， 家庭和卫生服务提供者对循证证据的了解和获取仍然有限 关心。为了解决这一关键差距，NIA AD/ADRD的传播和实施核心(D&I) HCS合作实验室将协助调查人员和利益相关者(HCS、PWD、照顾者、 提供者、付款人)在以下背景下实施和传播其痴呆症护理干预 EPCTS。这一核心建立在一个基本的科学假设之上：D&I方面的考虑至关重要 贯穿项目的整个生命周期(从创意构思、协议开发和测试到大范围 通过NIA阶段模型实施)，以优化干预措施融入HCS的潜力。一个 D&I核心的主要贡献将是推进和评估新框架的效用，以确定 干预的“准备程度”，以便继续进行ePCTS。D&I Core将由Laura N博士共同领导。 Gitlin和Joseph Gaugler，并包括一个由五个国际公认的执行委员会(EC)组成的 痴呆症实施研究方面的专家。D&I核心的活动将与和 由AD/ADRD合作实验室的利益攸关方参与和多样性/包容小组提供信息 领导委员会，以及试点、培训、设计/统计和监管/道德核心。具体的 目标是：目标1.进行、定期更新和传播关于以下方面的科学文献的综合 对残疾患者和/或照顾者实施非药物干预；目标2：提出一个框架 确定试点研究的发展阶段及其进行ePCT的准备情况；以及目标3： 提供持续的技术援助，以研究AD/ADRD合作实验室资助的试点项目的需求 领导者和职业发展奖获得者，以及NIA资助的其他调查人员从一开始就进行ePCT 项目的发展，以使他们能够推进其执行和传播计划。影响： 在残疾人和照顾者的HCS中广泛实施经证实的干预措施的持续失败 这在很大程度上是由于从干预措施发展的一开始就没有注意到研发科学。 开展电子通信技术将需要系统地注意在#年实施研究的证据做法。 复杂的，斑驳的HCS。D&I核心对于确保试点研究的实施成功至关重要 和ePCTS，以加强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.