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

摘要 据估计，美国医疗系统依赖1100万无偿(家人和朋友)护理伙伴提供 护理住院后的阿尔茨海默病和相关痴呆(ADRD)患者。尽管 认识到护理伙伴对于改善ADRD患者术后的健康状况至关重要 在住院期间，护理伙伴报告了对他们在住院过程中被纳入的不满。关怀 当患有ADRD的人回家时，伴侣们会觉得自己没有能力协助完成任务。身份证明， 评估和培训对于帮助护理伙伴完成ADRD患者的护理任务至关重要 住院后。我们建议开发ADRD系统医院包容家庭工具包(A-SHIFT)； 它将为医疗保健系统提供有关如何识别、评估和培训护理的实用指导 与ADRD一起生活的住院患者的伴侣。A-Shift将根据NIH阶段进行开发 建模并利用协作合作伙伴的观点，包括领先的老龄化和护理 科学家、医疗系统和临床医生，以及ADRD患者和他们的护理伙伴。具体来说， 对于目标1，我们将描述护理伙伴纳入ADRD患者的医院护理的模式； 目标2我们将确定医疗保健系统的促进者和障碍，并对医疗保健合作伙伴纳入 为ADRD患者提供医院护理；对于目标3，我们将共同设计A-Shift，以促进纳入 对患有ADRD的住院患者的护理伙伴。为了实现这些目标，我们将使用融合混合 方法采用系统工程方法进行设计。在目标1中，我们将直接观察临床医生 与患有ADRD的住院患者和目前的护理合作伙伴互动，并提取与工作流程相关的信息 来自电子病历的数据，以了解识别、评估和培训的当代实践 关爱伙伴。在目标2中，我们将采访和调查主要利益相关者，以确定促进者和障碍并对其评级 用于护理合作伙伴的识别、评估和培训。在目标3中，我们将召集两个设计团队，包括 关键利益相关者将同时努力开发A-Shift。圆满完成拟议中的 AIMS将产生A-SHFT原型，我们随后将测试其可行性，然后直接推出混合动力车 有效性/有效性试验测试A-Shift在增加护理伙伴准备和减少 患有ADRD的人可以避免再次住院。作为这项工作的结果，我们希望关怀合作伙伴 在A-Shift的帮助下，在ADRD患者的住院期间获得有意义的纳入。

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.