Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce

评估以人为本的国家培训计划，以加强痴呆症护理人员队伍

• 批准号: 10679067
• 负责人: Sheryl Zimmerman
• 金额: $ 74.99万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10679067
• 关键词: Adoption; Age Years; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Assisted Living Facilities; Attitude; Beds; Behavior; Caring; Case Mixes; Certification; Characteristics; Cluster randomized trial; Communities; Community Healthcare; Community Participation; Competence; Computers; Country; Data; Dementia; Development; Discipline of Nursing; Education; Educational process of instructing; Effectiveness; Family; Family member; Feeling; Hour; Impaired cognition; Individual; Injury; Intention; Knowledge; Learning; Licensing; Long-Term Care; Minority; Modeling; National Institute on Aging; Occupations; Outcome; Perception; Personal Satisfaction; Persons; Preparation; Procedures; Provider; Psychological reinforcement; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reaction; Reporting; Residential Treatment; Self Care; Severities; Tablet Computer; Testing; Training; Training Programs; Waiting Lists; Workplace; arm; behavior change; burnout; care outcomes; care providers; community living; cost; dementia care; effectiveness evaluation; effectiveness/implementation hybrid; evidence base; expectation; experience; handheld mobile device; high school; improved; improved outcome; interest; peer support; person centered; programs; recruit; residential care facility; response; skills; skills training; virtual

Project Summary/Abstract More than 75% of persons living with Alzheimer's disease and related dementias who reach 80 years of age require residential long-term care, which is increasingly provided in assisted living (AL). Across the country, almost 29,000 AL communities with more than 996,000 beds have become the primary residential care provider for persons with dementia: 90% of AL residents have cognitive impairment and 42% have recorded moderate or severe dementia, with actual rates being higher. AL provides supportive but not nursing services; consequently, virtually all care is provided by direct care workers (nursing assistants and personal care aides). Unfortunately, direct care workers are undervalued and undertrained, leading to poor care, workplace injury, dissatisfaction, and high turnover. AL is state-regulated, and only 17 states stipulate minimum training hours (some being as low as one hour), meaning that two-thirds of states are silent on training. Fewer than 40% of staff have education beyond high school, and so it is not surprising that a minority report sufficient knowledge to care for persons with dementia. In striving to fill this gap, training for direct care workers must be accessible and have efficacy in benefitting the staff, organization, and persons with dementia. Online training is an especially promising option due to its low cost, wide availability, and potential for self- pacing, automated skills tests, and certification. The Alzheimer's Association is the national leader in dementia care training, and in 2021 developed essentiALZTM (pronounced “essentials”), an online program teaching evidence-based, person-centered care, which can be accessed from a computer, tablet, or mobile device. Already more than 1,500 staff have essentiALZ certification, but as is true of the majority of training programs, evidence as to its ability to improve care and outcomes is lacking. It is possible that essentiALZ is effective in changing care and outcomes, but it may also be that additional supports are necessary to do so. A timely model of support is Project ECHO, which has flooded the field of long-term care as a proven way to provide expert guidance and peer support via a remote, online approach. Adding ECHO to online dementia training might provide a necessary boost to achieve care change and improved outcomes. The proposed project responds to the NIA Notice of Special Interest that calls for strengthening the workforce through enhancing and supporting skills training. It will conduct a hybrid implementation/effectiveness cluster- randomized trial in 126 AL communities across six states, comparing essentiALZ alone, essentiALZ + ECHO enhancement, and a waitlist control. Outcomes grounded in the RE-AIM model and the Kirkpatrick training effectiveness model will be examined over six months, comparing the arms in terms of (1) implementation and (2) effectiveness, and (3) examining the extent to which implementation and effectiveness differ based on characteristics of the AL community, staff, residents, and family members. Results will inform next steps in dementia care training for the AL and broader long-term care workforce.

项目概要/摘要 超过 75% 的阿尔茨海默氏病及相关痴呆症患者年过 80 岁 需要长期住院护理，这种服务越来越多地通过辅助生活 (AL) 提供。在全国范围内， 近29,000个拥有超过996,000张床位的AL社区已成为初级住宿护理 痴呆症患者的提供者：90% 的 AL 居民有认知障碍，42% 的人有记录 中度或重度痴呆症，实际发病率更高。 AL 提供支持服务，但不提供护理服务； 因此，几乎所有护理均由直接护理人员（护理助理和个人护理助理）提供。 不幸的是，直接护理人员的价值被低估且培训不足，导致护理质量差、工伤、 不满意，人员流动率高。 AL 受州监管，只有 17 个州规定了最低培训时数 （有些时间短至一小时），这意味着三分之二的州对培训保持沉默。少于 40% 工作人员受过高中以上教育，因此少数人报告有足够的知识也就不足为奇了 照顾痴呆症患者。为了努力填补这一空白，必须为直接护理人员提供培训 并有效造福员工、组织和痴呆症患者。 在线培训因其成本低、可用性广泛以及自我培训的潜力而成为一种特别有前途的选择。 节奏、自动化技能测试和认证。阿尔茨海默病协会是全国痴呆症领域的领导者 护理培训，并于 2021 年开发了 essentiALZTM（发音为“essentials”），这是一个在线课程教学 基于证据、以人为本的护理，可以通过计算机、平板电脑或移动设备进行访问。 已有超过 1,500 名员工拥有 essentiALZ 认证，但正如大多数培训计划一样， 缺乏证据证明其改善护理和结果的能力。 essentiALZ 可能有效 改变护理和结果，但也可能需要额外的支持才能做到这一点。及时的 支持的模式是 ECHO 项目，该项目已成为长期护理领域的一个行之有效的提供 通过远程在线方法提供专家指导和同行支持。将 ECHO 添加到在线痴呆症培训中 可能会为实现护理变革和改善结果提供必要的推动力。 拟议项目响应 NIA 特别利益通知，该通知呼吁加强劳动力 通过加强和支持技能培训。它将进行混合实施/有效性集群—— 在六个州的 126 个 AL 社区中进行的随机试验，比较单独使用 essentiALZ、essentiALZ + ECHO 增强和候补名单控制。基于 RE-AIM 模型和柯克帕特里克训练的结果 有效性模型将在六个月内进行审查，在（1）实施和 (2) 有效性，以及 (3) 检查实施和有效性的差异程度 AL 社区、员工、居民和家庭成员的特征。结果将告知下一步 为 AL 和更广泛的长期护理人员提供痴呆症护理培训。