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

描述(申请人提供)：痴呆症是一种破坏性的神经退行性疾病，是疾病负担的最大单一原因，给痴呆症患者及其家人带来了与健康相关的大量费用，并增加了不成比例的医疗和社会服务成本。在缺乏治愈或广泛有效的药物疗法来对抗痴呆症及其与健康相关的后果的情况下，迫切需要在现有服务计划中转换和实施有效的非药物干预措施，以改善痴呆症患者及其家庭照顾者(CG)的健康相关结果，从而帮助避免或推迟昂贵的住院和疗养院入院。因此，针对PA-11-123，建议进行一项转化性研究，将循证干预措施--护理环境中的痴呆症患者(COPE)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高危老年人的综合医疗补助豁免和国家财政资助的家庭护理计划。COPE是一项为期4个月的居家非药物干预，使用职业治疗师和高级执业护士来最大化患有痴呆症的老年人的身体功能，并提高CGs的痴呆症管理技能。患有痴呆症的CHCPE患者及其CGs(n=290对)将被随机分配接受COPE加惯常CHCPE服务，或仅接受惯常CHCPE服务。研究结果的衡量标准将与最初的COPE疗效试验类似。将进行成本效益分析，以确定在传统CHCPE服务的基础上增加COPE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范围传播计划。针对CHCPE患者的研究目标：目标1.1：确定随机化后4个月(在4个月时)对功能依赖的应对效果。目标1.2：在4个月后，确定应对方式对活动参与度、生活质量和神经精神症状(NPS)的影响。目标1.3：在12个月时，确定应对方式对功能依赖、活动投入、生活质量和NPS的影响。针对CGS的研究目标：目标2.1：在4个月时确定应对方式对感知的CG幸福感的影响。目标2.2：在4个月后确定应对对使用痴呆治疗策略的信心的影响。目标2.3：在12个月时，确定应对方式对CG感知的幸福感、使用活动的信心以及将客户留在家中的能力的影响。翻译研究目标：目标3.1：确定COPE的净财务收益，包括COPE干预成本、CHCPE常规护理成本、疗养院成本和其他服务成本，分别为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COPE落实到CHCPE的可行性和可接受性。这项转化性研究将成为在公共资助的家庭护理项目中嵌入和评估循证服务的国家模型，这些项目针对有可能进入养老院的痴呆症老年人。

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.