Indian Transforming Alzheimer's Care Training

印度转变阿尔茨海默病护理培训

• 批准号: 10459241
• 负责人: Patrik Lennart Johansson
• 金额: $ 34.02万
• 依托单位: WASHINGTON STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10459241
• 关键词: Academy; Alaska Native; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; Alzheimer' s disease risk; American; American College of Physicians; American Indians; Antidepressive Agents; Behavior; Caregiver support; Caring; Cholinesterase Inhibitors; Chronic; Clinic; Communities; Complex; Computerized Medical Record; Current Procedural Terminology Codes; Data; Dementia; Diagnosis; Education; Elderly; Electronic Health Record; Elements; Evaluation; Family; Fostering; Geriatric Assessment; Geriatrics; Health; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Impaired cognition; Intervention; Interview; Knowledge; Medicare; N-Methylaspartate; Neuropsychology; Outcome; Outcome Measure; Pamphlets; Patient Education; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Population Projection; Primary Care Physician; Primary Health Care; Privatization; Quality of Care; Questionnaires; Race; Randomized; Research; Research Project Grants; Reservations; Resources; Rural; Services; Site; Societies; System; Testing; Time; Training; Training and Education; United States Dept. of Health and Human Services; United States Indian Health Service; Waiting Lists; aged; antagonist; base; care outcomes; cognitive testing; common treatment; dementia care; design; diagnosis quality; follow-up; health care service; health training; improved; informant; innovation; medical specialties; mild cognitive impairment; native elder; pragmatic trial; programs; randomized trial; rapid growth; rural setting; screening; skills; symposium; trend; urban Native American

RESEARCH PROJECT 1: ABSTRACT The American Indian and Alaska Native (AI/AN) population is growing 3 times faster than the US all-races population. The number of AI/ANs aged 65+ is expected to triple to 1,624,000 by 2050, while the number of those aged 85+ will increase 7-fold to 300,000. These trends raise concerns about proportionate increases in Alzheimer’s disease and related dementias (ADRD) among AI/AN elders, and concurrent demands for ADRD healthcare and services. Many AI/ANs obtain healthcare through a fragmented system that offers minimal geriatric or specialty care and creates barriers to obtaining high-quality care, resulting in late or under-diagnosis and inadequate care for ADRD. AI/AN elders typically receive their healthcare from primary care physicians (PCPs), who often lack the training and resources needed to diagnose and manage ADRD. The focus of the 2016 Alzheimer’s Disease-Related Dementias Summit was on improving skills in the community by training health professionals in dementia diagnosis, care, and research. PCPs are especially well-placed to detect mild cognitive impairment, which is often undiagnosed. While studies suggest that clinic-level interventions can improve ADRD diagnosis and care, no pragmatic trial has focused on facilities or PCPs that serve AI/ANs. In partnership with an urban clinic serving AI/ANs, we therefore designed “INdians Transforming Alzheimer’s Care Training” (INTACT), a clinic-level intervention to improve ADRD diagnosis and quality of care for AI/ANs. The active principal component of INTACT is PCP training in screening, diagnosis, and care for ADRD. Other elements include patient and family education, culturally informed videos, and brochures to create a “dementia- friendly clinic”. First, we will conduct key informant interviews with PCPs in rural clinics to adapt the existing version of INTACT for delivery in rural settings. Second, we will test INTACT with a group-randomized trial at 14 urban and 14 rural clinics that provide primary care to AI/ANs using a wait-control design. At the clinic level, we will rely on electronic medical records to document INTACT’s effect on new ADRD diagnoses. At the PCP level, we will test whether INTACT increases self-reported knowledge and confidence in dementia assessment, ADRD care, and caregiver support. Third, we will evaluate INTACT’s effect on clinic- and patient-level outcomes. Although we will not collect data directly from patients, we will examine patient-level quality of care metrics documented in electronic medical records for AI/ANs with ADRD. Our Specific Aims are to: 1) Adapt INTACT for use in rural clinics serving AI/ANs; 2) Conduct a GRT to test INTACT’s effects on PCP knowledge of ADRD, care confidence, and practice behavior; and 3) Evaluate INTACT’s effect on clinic-level outcomes (new diagnoses) and patient-level quality of care outcomes (e.g., treatments commonly used for ADRD). The rapid growth of the elderly AI/AN population forecasts a ballooning number of Native elders at risk of ADRD. This study will be one of the few trials of a clinic-level intervention that foregrounds PCP education and training to improve ADRD care, and the only one designed for AI/AN communities.

研究项目 1：摘要 美洲印第安人和阿拉斯加原住民 (AI/AN) 人口增长速度是美国所有种族人口的 3 倍 人口。到 2050 年，65 岁以上的 AI/AN 人数预计将增加两倍，达到 1,624,000 人，而 85岁以上的人口将增加7倍，达到30万。这些趋势引起了人们对比例增长的担忧 AI/AN 老年人中的阿尔茨海默病和相关痴呆症 (ADRD) 以及对 ADRD 的并发需求 医疗保健和服务。许多 AI/AN 通过一个分散的系统获得医疗保健，该系统提供的服务很少 老年科或专科护理，为获得高质量护理造成障碍，导致延迟诊断或诊断不足 对 ADRD 的护理不足。 AI/AN 老年人通常从初级保健医生那里获得医疗保健 （PCP），他们往往缺乏诊断和管理 ADRD 所需的培训和资源。重点是 2016 年阿尔茨海默病相关痴呆症峰会的主题是通过培训提高社区技能 痴呆症诊断、护理和研究领域的卫生专业人员。 PCP 特别适合检测 轻度认知障碍，通常未被诊断。虽然研究表明临床层面的干预措施可以 改善 ADRD 诊断和护理，但没有任何实用试验重点关注为 AI/AN 提供服务的设施或 PCP。在 因此，我们与一家为 AI/AN 提供服务的城市诊所合作，设计了“印第安人改变阿尔茨海默病护理 培训”（INTACT），一种临床水平的干预措施，旨在改善 ADRD 诊断和 AI/AN 的护理质量。 INTACT 的主要组成部分是针对 ADRD 筛查、诊断和护理的 PCP 培训。其他 元素包括患者和家庭教育、文化知识视频和小册子，以创建“痴呆症” “友好诊所”。首先，我们将对农村诊所的主治医生进行关键信息访谈，以适应现有的 用于在农村地区交付的 INTACT 版本。其次，我们将在 14 点通过分组随机试验来测试 INTACT 城市和 14 个农村诊所使用等待控制设计为 AI/AN 提供初级保健。在临床层面，我们 将依靠电子病历来记录 INTACT 对新 ADRD 诊断的影响。在 PCP 层面， 我们将测试 INTACT 是否会增加自我报告的痴呆症评估、ADRD 知识和信心 护理和护理人员支持。第三，我们将评估 INTACT 对临床和患者水平结果的影响。 尽管我们不会直接从患者那里收集数据，但我们将检查患者级别的护理质量指标 记录在患有 ADRD 的 AI/AN 的电子病历中。我们的具体目标是： 1) 完整适应 用于为 AI/AN 提供服务的农村诊所； 2) 进行 GRT 以测试 INTACT 对 PCP ADRD 知识的影响， 关心信心，践行行为； 3) 评估 INTACT 对临床水平结果的影响（新 诊断）和患者层面的护理结果质量（例如 ADRD 常用的治疗方法）。快速的 老年 AI/AN 人口的增长预示着面临 ADRD 风险的原住民老年人数量将不断增加。这项研究 将是少数几个以 PCP 教育和培训为基础的临床干预试验之一，以改善 ADRD 护理，也是唯一为 AI/AN 社区设计的护理。