Supporting Dementia Caregivers During Medicare Home Health: Developing the DECLARE Needs Assessment Intervention

在 Medicare 家庭健康期间支持痴呆症护理人员：制定 DECLARE 需求评估干预措施

• 批准号: 10643284
• 负责人: Julia Burgdorf
• 金额: $ 13.38万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643284
• 关键词: Address; Admission activity; Adverse event; Advisory Committees; Aftercare; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; Area; Assessment tool; Caregiver support; Caregivers; Caring; Clinical; Collaborations; Communication; Communities; Data; Data Collection; Dementia caregivers; Deterioration; Discipline of Nursing; Doctor of Philosophy; Elderly; Electronic Health Record; Electronics; Eligibility Determination; Evaluation; Face; Family; Family Caregiver; Feedback; Focus Groups; Fostering; Funding; Future; Goals; Grant; Health; Health Personnel; Health system; Healthcare Industry; Home; Home Care Services; Home Health Care Agencies; Hospitalization; Hour; Individual; Infrastructure; Institutionalization; Intake; Intervention; Intervention Studies; Interview; Lead; Learning; Letters; Link; Measures; Medical; Medicare; Mentors; Mentorship; Methods; Modality; Needs Assessment; Notification; Nursing Services; Online Systems; Outcome; Pathway interactions; Patient Care; Patient risk; Patients; Persons; Pilot Projects; Policies; Positioning Attribute; Pragmatic clinical trial; Process; Provider; Randomized; Reporting; Research; Research Activity; Research Personnel; Resources; Risk; Running; Sampling; Schedule; Scientist; Self Assessment; Self Efficacy; Services; Source; Surveys; Technology; Testing; Time; Training; Training Activity; Visiting Nurse; Work; Workload; Writing; aging in place; beneficiary; care outcomes; care recipients; career; career development; caregiving; clinical care; community based care; community living; cost; dementia care; demographics; design; effective intervention; empowerment; experience; family support; health care quality; health care referral; health care settings; human centered design; improved; informant; innovation; intervention refinement; meetings; multidisciplinary; nonalzheimer dementia; nursing skill; online care; patient home care; pilot test; portability; prototype; satisfaction; skills; stakeholder perspectives; technology platform; therapy design; treatment as usual

PROJECT SUMMARY/ABSTRACT Through Medicare-funded skilled home health care (HH), community-living older adults may receive skilled nursing, therapy, and aide services in their home. HH is a crucial source of care for older adults with Alzheimer's Disease and Related Dementias (ADRD); 31% of the 3.4 million Medicare beneficiaries who access HH each year have ADRD. The majority (92%) of HH patients with ADRD require help from family and unpaid caregivers to implement the HH plan of care. Yet, caregiver needs are not systematically assessed during HH and they frequently face unmet training/support needs. Unmet caregiver needs contribute to increased costs, decreased patient/family satisfaction, and higher patient risk for hospitalization and institutionalization during HH. The proposed K01 will develop, refine, and pilot test an ADRD caregiver needs assessment intervention for HH: DECLARE (Dementia Caregivers' Link to Assistance and Resources). DECLARE will harness a web-based survey platform to elicit information from ADRD caregivers about their availability, capabilities, and needs at the time of HH admission. This data will then populate in the HH patient record along with suggested next steps for HH staff. Specific Aims include: (1) Develop an ADRD caregiver self-assessment intervention (DECLARE) prototype; (2) Iteratively refine the intervention (DECLARE) in partnership with key stakeholders; (3) Implement and pilot test DECLARE via an embedded Pragmatic Clinical Trial, evaluating for feasibility, acceptability, and impact on HH care team/caregiver communication and support. Aims will be pursued in partnership with Visiting Nurse Service of New Yok (VNSNY), the largest non-profit HH provider in the nation. Findings will support a planned R01 to test DECLARE's impact on patient clinical outcomes and caregiver self-efficacy and burden. Dr. Julia Burgdorf, PhD, is a Research Scientist at the Center for Home Care Policy & Research at VNSNY. She is ideally positioned to lead the proposed research as an expert in family caregiver involvement in HH care and an embedded researcher at VNSNY. Her career goal is to improve home- and community-based care for older adults by developing pragmatic clinical interventions that facilitate provider-led engagement and support of family caregivers, with a focus on caregivers for individuals with ADRD. To achieve this goal, Dr. Burgdorf will pursue targeted mentorship and training in 5 key areas during the K01: (1) consumer-facing technologies for clinical innovation in HH, (2) human-centered design, (3) intervention evaluation and embedded Pragmatic Clinical Trials, (4) ADRD research, and (5) independent grant writing. She has assembled an interdisciplinary mentoring and advisory team whose complementary research expertise and experience mentoring early career investigators will provide invaluable support and guidance, while fostering her ongoing collaborations with academic research settings and a major learning health system. This K01 would provide Dr. Burgdorf with the necessary time and learning experiences to transition to an independent investigator equipped to lead impactful interventional research improving provider/caregiver collaboration and care outcomes in the HH setting.

项目总结/摘要 通过联邦医疗保险资助的熟练家庭医疗保健（HH），社区生活的老年人可以接受熟练的 护理，治疗和援助服务在他们的家。HH是老年痴呆症患者护理的重要来源 疾病及相关痴呆症（ADRD）; 340万名医疗保险受益人中的31%， 年有ADRD。大多数（92%）HH ADRD患者需要家人和无偿护理人员的帮助 实施HH护理计划。然而，在HH期间没有系统地评估护理人员的需求， 经常面临未得到满足的培训/支助需求。未满足的照顾者需求导致成本增加， 患者/家属满意度，以及HH期间住院和机构化的患者风险更高。的 拟定的K 01将为HH制定、完善和试点测试ADRD护理者需求评估干预措施： 痴呆症照顾者的帮助和资源链接（Dementia Caregivers' Link to Assistance and Resources）DEDENCE将利用一个基于网络的 调查平台，以获取ADRD护理人员关于其可用性、能力和需求的信息， HH入场时间然后，该数据将与建议的后续步骤一起填充到HH患者记录中， HH员工。具体目标包括：（1）制定ADRD照顾者自我评估干预（DEFEE） 原型;（2）与关键利益攸关方合作，反复完善干预措施（DEODE）;（3）实施 并通过嵌入式实用临床试验对DESIDE进行试点测试，评估其可行性、可接受性和 影响HH护理团队/护理人员沟通和支持。将与来访的伙伴合作实现目标 Nurse Service of New Yok（VNSNY）是全美最大的非营利HH提供者。调查结果将支持 计划的R 01测试DECARE对患者临床结局和护理人员自我效能和负担的影响。 Julia布尔格多夫博士是VNSNY居家照护政策与研究中心的研究科学家。 作为家庭护理人员参与HH护理的专家，她是领导拟议研究的理想人选 和VNSNY的嵌入式研究员。她的职业目标是改善家庭和社区护理， 通过制定务实的临床干预措施，促进提供者主导的参与和支持， 家庭照顾者，重点是ADRD患者的照顾者。为了实现这一目标，布尔格多夫博士将 在K 01期间，在5个关键领域进行有针对性的指导和培训：（1）面向消费者的技术， HH的临床创新，（2）以人为本的设计，（3）干预评估和嵌入式实用 临床试验，（4）ADRD研究，和（5）独立授权写作。她组建了一个跨学科的 指导和咨询团队，其互补的研究专业知识和经验指导早期职业生涯 调查人员将提供宝贵的支持和指导，同时促进她与 学术研究设置和主要的学习健康系统。该K 01将为布尔格多夫博士提供 过渡到独立调查员所需的时间和学习经验， 干预性研究，改善提供者/护理人员的合作和护理成果，在HH设置。