The Care Ecosystem Response to COVID-19: Accelerating Research on Dementia Care that Meets the Needs of Caregivers and Persons with Dementia during COVID-19

护理生态系统对 COVID-19 的响应：加速痴呆症护理研究，满足 COVID-19 期间护理人员和痴呆症患者的需求

• 批准号: 10634511
• 负责人: Katherine Laurel Possin
• 金额: $ 296.74万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634511
• 关键词: Acceleration; Bed Occupancy; Behavior; Behavioral Symptoms; Black race; COVID-19; COVID-19 pandemic; Caregiver Burden; Caregiver support; Caregiver well-being; Caregivers; Caring; Clinical; Communication; Communities; Community Health; Complex; Data; Dementia; Dementia caregivers; Development; Discipline of Nursing; Ecosystem; Effectiveness; Electronic Health Record; Emergency department visit; Emergency medical service; Enrollment; Environment; Evaluation; Family; Family Caregiver; Fee-for-Service Plans; Fright; Future; Geography; Goals; Health Personnel; Health system; Healthcare; Healthcare Systems; Home; Hospitalization; Infection; Internet; Intervention; Interview; Latinx; Licensing; Locales; Medical; Medicare claim; Mental Depression; Methods; Modeling; Monitor; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population Heterogeneity; Primary Care; Protocols documentation; Provider; Public Health; Quality of Care; Quality of life; Research; Resources; Risk; Risk Adjustment; Rural; Sampling; Science; Services; Site; Social Work; Social isolation; Specialist; Structure; Supportive care; Surveys; Technology; Telephone; Time; Training; Underrepresented Populations; Underserved Population; Vulnerable Populations; Work; advanced dementia; advanced disease; barrier to care; caregiver depression; cohort; collaborative care; comparison group; cost; dementia care; design; effectiveness evaluation; effectiveness study; ethnic minority population; evidence base; experience; family burden; health care model; high risk; hospital readmission; implementation barriers; implementation facilitators; implementation science; implementation strategy; implementation/effectiveness; improved; improved outcome; pandemic disease; patient population; person centered; pragmatic trial; primary outcome; programs; racial minority population; randomized, clinical trials; remote delivery; remote health care; response; satisfaction; secondary outcome; standardized care

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients and caregivers, which have been exacerbated by the COVID- 19 pandemic. The current state of dementia care is inadequate to meet the needs of this growing, vulnerable population. Scalable, effective, and person-centered dementia care models that are aligned with value-based healthcare reforms are needed now. The Care Ecosystem is an accessible, remotely delivered team-based dementia care model, designed to add value for patients, providers and payers in complex organizational and reimbursement structures. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a team of dementia specialists with nursing, social work, and pharmacy expertise. Care Protocols guide proactive, quality care that is documented in the electronic health record. The evidence base to date suggests that the Care Ecosystem improves outcomes important to people with dementia, caregivers, and payers when delivered in a controlled research environment, including reduced emergency department visits, higher quality of life for patients and lower caregiver depression. We propose a rapid pragmatic trial in 6 health systems serving geographically and culturally diverse populations. We will leverage technology, delivering care via the phone and web and using electronic health records to monitor quality improvements and evaluate outcomes while maximizing external validity. In Aim 1, we will use implementation science to identify the model adaptations, facilitators, and barriers to implementing and sustaining the Care Ecosystem during the COVID-19 pandemic. In Aim 2 we will use mixed methods to rigorously evaluate the effectiveness of the Care Ecosystem on outcomes important to patients, caregivers, healthcare providers, and health systems during the pandemic. In Aim 3, we will characterize the patient and caregiver factors associated with treatment benefit. This will include investigating effectiveness in underrepresented groups and elucidating unmet needs that will guide future development work. By simultaneously evaluating the real-world effectiveness and implementation strategies in diverse health systems, this project will bridge the science-practice gap in dementia care during an unprecedented time of heightened strain on family caregivers, healthcare providers and health systems. Furthermore, this work will pave the way for expanding access to high quality dementia care in the future, mitigating the negative impact of dementia on patients and their families across the nation.

项目总结/文摘