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

摘要 美国的医疗保健系统依赖于大约1100万名无偿（家庭和朋友）护理伙伴提供服务。 老年痴呆症和相关痴呆症（ADRD）患者住院后的护理。尽管 认识到护理伙伴对于优化ADRD患者的健康结局至关重要， 在住院期间，护理伙伴报告对他们在住院过程中的参与感到不满。护理 当患有ADRD的人回家时，伴侣感到没有能力帮助完成任务。身份证， 评估和培训对于使护理合作伙伴能够为ADRD患者完成护理任务至关重要 住院后。我们建议开发ADRD系统化医院包容家庭工具包（A-ADRD）; 它将为医疗保健系统提供关于如何识别、评估和培训护理的实用指南 ADRD住院患者的伴侣。将根据NIH阶段开发A-BMPs 从合作伙伴那里建模和利用观点，包括领先的老化和老化 科学家、医疗保健系统和临床医生以及ADRD患者及其护理伙伴。具体地说， 对于目标1，我们将描述ADRD患者在医院护理中的护理伙伴纳入模式;对于 目标2：我们将确定和优先考虑医疗保健系统的促进者和障碍，以将护理伙伴纳入 至于目的3，我们会与其他机构合作设计A-Risk， ADRD住院患者的护理伙伴。为了实现这些目标，我们将使用一个融合的混合 方法设计与系统工程方法。在目标1中，我们将直接观察临床医生 与ADRD住院患者和当前护理伙伴的互动，并提取与工作流程相关的 从电子病历中获取数据，以了解识别、评估和培训的当代实践 关怀伙伴在目标2中，我们将采访和调查主要利益相关者，以识别和评估促进者和障碍 用于护理伙伴识别、评估和培训。在目标3中，我们将召集两个设计团队， 这些利益攸关方将共同努力，制定《行动纲领》。圆满完成拟议的 目标将导致一个A-SHFT原型，我们将随后测试的可行性，然后直接由混合动力 功效/有效性试验测试A-ESTA的有效性，在提高护理伙伴的准备和减少 ADRD患者可避免的再次入院。作为这项工作的结果，我们希望护理合作伙伴 在ADRD患者住院治疗期间，在A-Risk的帮助下获得有意义的包容。

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.