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.

项目总结/摘要 超过75%的阿尔茨海默病和相关痴呆症患者年龄达到80岁 需要长期居住护理，这是越来越多地提供辅助生活（AL）。在全国范围内， 近29，000个AL社区拥有超过996，000张床位，已成为主要的住宅护理 痴呆症患者的提供者：90%的AL居民有认知障碍，42%的人记录了 中度或重度痴呆，实际发病率更高。助理护士提供支援服务，但不提供护理服务; 因此，几乎所有的护理都由直接护理人员（护理助理和个人护理助理）提供。 不幸的是，直接护理人员被低估和培训不足，导致护理不善，工作场所受伤， 不满意和高流动性。AL是由州监管的，只有17个州规定了最低培训时间 (some这意味着三分之二的国家对培训保持沉默。不到40%的 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。在努力弥补这一差距时，必须为直接护理人员提供培训 并具有有益于工作人员、组织和痴呆症患者的功效。 在线培训是一个特别有前途的选择，由于其成本低，广泛的可用性，并有潜力自我- 自动化技能测试和认证。阿尔茨海默氏症协会是全国痴呆症的领导者 护理培训，并于2021年开发了essentiALZTM（发音为“必需品”），这是一个在线课程教学 循证、以人为本的护理，可通过计算机、平板电脑或移动终端访问。 已经有1,500多名员工获得了EssentialZ认证，但正如大多数培训项目一样， 缺乏证据表明其能够改善护理和成果。essentiALZ可能在以下方面有效： 改变护理和结果，但也可能需要额外的支持。及时 一种支持模式是ECHO项目，该项目已成为长期护理领域的一种行之有效的方式， 通过远程在线方式提供专家指导和同行支持。将ECHO添加到在线痴呆症培训中 可能为实现护理变革和改善结果提供必要的推动力。 拟议的项目响应了NIA特别关注通知，该通知要求加强劳动力队伍 加强和支持技能培训。它将开展一个混合型执行/成效集群， 在六个州的126个AL社区中进行的随机试验，比较了essentiALZ单独使用、essentiALZ + ECHO 增强功能和waitlist控件。基于RE-AIM模型和柯克帕特里克培训的结果 将在六个月内审查有效性模式，比较武器的（1）执行情况， (2)（3）检查执行和有效性的差异程度， AL社区，工作人员，居民和家庭成员的特点。结果将为下一步提供信息， 为AL和更广泛的长期护理人员提供痴呆症护理培训。