METRIcAL - Music & MEmory: a Pragmatic TRIal for Nursing Home Residents with ALzheimer's Disease

项目摘要 以证据为基础的非药物干预，解决行为和心理症状 老年痴呆症（BPSD）是疗养院（NH）的一个特别高的优先事项，其中超过50%的长期住院患者 居民患有阿尔茨海默病相关痴呆症（ADRD）和抗精神病药物的标签外使用 由于严重的不良后果，治疗BPSD的药物是禁忌的。 研究表明，个性化的音乐可以减少焦虑，减少负面影响， 抑郁症，并控制ADRD患者的身体激动行为。激发音乐记忆 熟悉或喜爱的音乐可以减少孤独感和焦虑感，因为音乐记忆是编码的。 在ADRD过程中受影响的大脑区域比参与言语记忆的大脑区域更晚， 执行功能音乐与记忆（M&M）是一个音乐节目，涉及使用廉价的iPod 为ADRD患者提供个性化音乐的技术。说明了干预的潜力 在2014年获奖的纪录片《活在内心》中， 开始移动，唱歌，并与他人互动时，听他们最喜欢的音乐的iPod。回顾性 布朗大学的分析发现，居民的BPSD症状在参加NHS的人中下降得更快， M&M与配对对照。然而，国家示范项目和其他项目表明， M&M的执行情况差别很大。作为标准化项目交付和评估的第一步， 为了提高效率，布朗及其合作伙伴制定了一份实施指南，整合了全州的经验， 关于NH最佳实践的定性数据的努力。 我们建议在为期一年的R21试点期间对M&M的引入和实施进行标准化， 然后测试实施M&M对NH居民在四年R33期间的BPSD结果的影响 务实的审判在试点期间，我们将测试逐步协议并验证数据传输， 在四个不同的国家卫生机构的测量程序，一个来自四个参与公司;在 务实的试验，我们将进行一项基于楔形的、务实的集群随机对照试验（RCT）， 估计M&M对居民行为和药物使用的影响，并检查因素 与66个机构的NHS坚持该计划的变化有关。使用等待列表控件设计 将使我们能够根据需要在参与浪潮之间迭代地改进培训和测量， 设施在试点和实际试验中，我们将把该计划作为一项设施级的协议来实施- 驱动，质量改进项目，针对所有符合条件（中度至重度ADRD）的居民参与 设施我们将使用iPod元数据、电子健康记录数据和最小数据集进行分析 居民评估，所有这些都可以链接到医疗保险登记和重要状态数据。

PROJECT SUMMARY Evidence-based, non-pharmacological interventions that address the behavioral and psychological symptoms of dementia (BPSD) are a particularly high priority for nursing homes (NHs), where over 50% of long-stay residents have Alzheimer's disease-related dementias (ADRD) and the off-label use of antipsychotic medications to address BPSD is contraindicated due to serious adverse consequences. Studies have demonstrated that individualized music can reduce anxiety, decrease negative affect or depression, and control physically-agitated behaviors in people with ADRD. Eliciting musical memories using familiar or preferred music may decrease feelings of isolation and anxiety, as musical memories are encoded in areas of the brain affected later in the ADRD process than areas of the brain involved in verbal memory and executive functioning. MUSIC & MEMORYSM (M&M) is a music program that involves using inexpensive iPod technology to deliver individualized music to people with ADRD. The intervention's potential is illustrated powerfully in the award-winning 2014 documentary, Alive Inside, which shows residents with severe dementia begin to move, sing, and interact with others when listening to their favorite music on iPods. Retrospective Brown University analyses found that residents' BPSD symptoms decreased faster among NHs participating in M&M vs. pair-matched controls. However, state demonstration programs and other projects demonstrate that implementation of M&M varies widely. As a first step to standardizing delivery of the program and evaluating efficacy, Brown and its partners developed an implementation guide, integrating experiences from statewide efforts with qualitative data about NH best practices. We propose to standardize the introduction and implementation of M&M during a one-year R21 pilot and then to test the impact of implementing M&M on NH residents' BPSD outcomes during a four-year R33 pragmatic trial. During the pilot, we will test a step-by-step protocol and validate data transfer and measurement procedures in four different NHs, one from each of four participating corporations; during the pragmatic trial, we will conduct a wedge-based, pragmatic cluster randomized controlled trial (RCT) and estimate the impact of M&M on residents' behaviors and medication use, as well as examine factors associated with variation in NHs' adherence to the program in 66 facilities. Using a waiting list control design will allow us to iteratively refine training and measurement, as needed, between waves of participating facilities. In both the pilot and the pragmatic trial, we will implement the program as a facility-level, protocol- driven, quality improvement project, targeting all eligible (moderate to severe ADRD) residents in participating facilities. We will conduct analyses using iPod metadata, electronic health record data, and Minimum Data Set resident assessments, all of which can be linked to Medicare enrollment and vital status data.