Development of the ADRD Systematic Hospital Inclusion Family Toolkit: A-SHIFT

摘要

ABSTRACT The U.S. healthcare system relies on an estimated 11 million unpaid (family and friend) care partners to provide care to people living with Alzheimer’s disease and related dementias (ADRD) after hospitalizations. Despite acknowledgement that care partners are critical to optimizing health outcomes of patients living with ADRD after hospitalization, care partners report dissatisfaction with their inclusion during the hospitalization process. Care partners feel ill-equipped to assist in tasks when the person living with ADRD returns home. Identification, assessment, and training are critical to equip care partners to fulfill caregiving tasks for people living with ADRD after hospitalization. We propose to develop the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT); which will provide healthcare systems practical guidance regarding how to identify, assess, and train care partners of hospitalized people living with ADRD. A-SHIFT will be developed in accordance with the NIH Stage Model and leveraging perspectives from collaborative partners that include leading aging and caregiving scientists, healthcare systems and clinicians, and people living with ADRD and their care partners. Specifically, for Aim 1 we will characterize patterns of care partner inclusion in hospital care for people living with ADRD; for Aim 2 we will identify and prioritize healthcare system facilitators and barriers to the inclusion of care partners in hospital care for people living with ADRD; and for Aim 3 we will co-design the A-SHIFT to facilitate the inclusion of care partners of hospitalized people living with ADRD. To address these aims, we will use a convergent mixed methods design with systems engineering methods. In Aim 1, we will conduct direct observations of clinician interactions with hospitalized people living with ADRD and present care partners and extract workflow-related data from electronic medical records to understand contemporary practice for identifying, assessing, and training care partners. In Aim 2, we will interview and survey key stakeholders to identify and rate facilitators and barriers for care partner identification, assessment, and training. In Aim 3, we will convene two design teams consisting of key stakeholders that will work in parallel to develop the A-SHIFT. Successful completion of the proposed aims will result in an A-SHFT prototype, which we will subsequently test for feasibility followed directly by a hybrid efficacy/effectiveness trial testing A-SHIFT’s effectiveness at increasing care partner preparedness and reducing avoidable hospital readmissions by people with ADRD. As a result of this work, we expect care partners to receive meaningful inclusion during the hospitalization of people living with ADRD with the help of A-SHIFT.