Translation of COPE for Publicly-Funded Home Care Clients and their Families

描述（由申请人提供）：痴呆症是一种毁灭性的神经退行性疾病，是疾病负担的最大单一原因，对痴呆症患者及其家庭造成了大量与健康相关的费用，并且不成比例地增加了健康和社会服务费用。在缺乏治愈或广泛有效的药物疗法来对抗痴呆及其健康相关后果的情况下，迫切需要将有效的非药物干预措施转化和实施到现有的服务计划中，以改善患有痴呆的个体及其家庭照顾者（CG）的健康相关结果，从而帮助避免或延迟昂贵的住院和疗养院入院。因此，为了响应PA-11-123，提出了一项转化研究，其中将循证干预措施，痴呆症患者在其环境中的护理（科普）纳入康涅狄格州老年人家庭护理计划（CHCPE），这是一项针对养老院入院风险高的老年人的医疗补助豁免和州收入资助的家庭护理计划。科普是一种为期4个月的家庭非药物干预，使用职业治疗师和高级实践护士，以最大限度地提高老年痴呆症患者的身体功能，并提高CG的痴呆症管理技能。患有痴呆症的CHCPE客户及其CG（n=290对）将被随机分配接受科普加常规CHCPE服务，或仅接受常规CHCPE服务。研究结局指标将与原始科普疗效试验相似。将进行成本效益分析，以确定将科普添加到常规CHCPE服务中的潜在经济效益，并将仔细研究实施过程。由老龄网络和其他领导人组成的翻译咨询委员会将帮助制定和指导国家科普传播计划。CHCPE客户的研究目的：目的1.1：确定随机化后4个月（4个月）科普对功能依赖的影响。目的1.2：在4个月时确定科普对活动参与、生活质量和神经精神症状的影响。目的1.3：确定科普对12个月时的功能依赖性、活动参与度、生活质量和生活质量的影响。研究针对CG：目标2.1：确定科普对4个月时感知的CG幸福感的影响。目的2.2：确定科普对4个月时使用痴呆症管理策略的信心的影响。目标2.3：确定科普对12个月时CG感知幸福感、使用活动的信心和让客户留在家中的能力的影响。翻译研究的目的：目标3.1：确定科普的净经济效益，占科普干预成本，CHCPE通常的护理成本，疗养院的成本，和其他服务成本，在4个月和12个月。目标3.2：从多个利益攸关方的角度，确定将科普纳入CHCPE的可行性和可接受性。这项转化研究将作为一个国家模式，用于在公共资助的家庭护理计划中嵌入和评估循证服务，为有老年痴呆症风险的老年人提供养老院入院。

DESCRIPTION (provided by applicant): Dementia, a devastating neurodegenerative disease, is the single biggest cause of disease burden, exacting a substantial health-related toll on individuals with dementia and their families and disproportionately higher health and social service costs. In the absence of a cure or widely effective pharmacotherapy to combat dementia and its health-related consequences, translation and implementation of efficacious non- pharmacologic interventions into existing service programs are sorely needed to improve health-related outcomes for individuals with dementia and their family caregivers (CGs), thereby helping avoid or delay costly hospitalizations and nursing home admissions. Accordingly, in response to PA-11-123, a translational study is proposed in which an evidence-based intervention, Care of Persons with Dementia in their Environments (COPE), is incorporated into the Connecticut Home Care Program for Elders (CHCPE), a combined Medicaid waiver and state revenue-funded home care program for older adults at high risk for nursing home admission. COPE is a 4-month, in-home, non-pharmacologic intervention using occupational therapists and advanced practice nurses to maximize physical function in older adults with dementia and improve dementia management skills of CGs. CHCPE clients with dementia and their CGs (n=290 dyads) will be randomly assigned to receive COPE plus customary CHCPE services, or customary CHCPE services alone. Study outcome measures will be similar to those of the original COPE efficacy trial. A cost-benefit analysis will be conducted to determine the potential economic benefit of adding COPE to customary CHCPE services, and implementation processes will be carefully studied. A Translational Advisory Committee composed of Aging Network and other leaders will help develop and guide national COPE dissemination plans. Study aims for CHCPE clients: Aim 1.1: Determine COPE effect on functional dependence 4 months after randomization (at 4 months). Aim 1.2: Determine COPE effects on engagement in activities, quality of life, and neuropsychiatric symptoms (NPS), at 4 months. Aim 1.3: Determine COPE effects on functional dependence, engagement in activities, quality of life, and NPS, at 12 months. Study aims for CGs: Aim 2.1: Determine COPE effect on perceived CG well-being at 4 months. Aim 2.2: Determine COPE effects on confidence in using dementia management strategies at 4 months. Aim 2.3: Determine COPE effects on CG perceived well-being, confidence in using activities, and ability to keep client at home, at 12 months. Translational study aims: Aim 3.1: Determine the net financial benefit of COPE, accounting for COPE intervention costs, CHCPE usual care costs, nursing home costs, and other service costs, at 4 and 12 months. Aim 3.2: Determine the feasibility and acceptability of COPE implementation into the CHCPE from multiple stakeholder viewpoints. This translational study will serve as a national model for embedding and evaluating evidence-based services in publicly-funded home care programs for older adults with dementia at risk for nursing home admission.