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人造成了巨大的健康相关损失，并造成了不成比例的更高的健康和社会服务成本。在缺乏治愈或广泛有效的药物治疗来对抗痴呆症及其与健康相关的后果的情况下，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，以改善痴呆症患者及其家庭照顾者（CGs）的健康相关结果，从而帮助避免或延迟昂贵的住院和养老院入院。因此，为了响应PA-11-123，我们提出了一项转化研究，其中一项基于证据的干预措施，即痴呆症患者在其环境中的护理（COPE），被纳入康涅狄格州老年人家庭护理计划（CHCPE），这是一项结合医疗补助豁免和国家收入资助的老年人家庭护理计划。COPE是一项为期4个月的家庭非药物干预，由职业治疗师和高级执业护士进行，以最大限度地提高老年痴呆症患者的身体功能，并提高老年痴呆症患者的管理技能。患有痴呆症的CHCPE患者及其CGs （n=290对）将被随机分配接受COPE加常规CHCPE服务，或单独接受常规CHCPE服务。研究结果将与最初的COPE疗效试验相似。将进行成本效益分析，以确定将COPE添加到传统的CHCPE服务中的潜在经济效益，并将仔细研究实施过程。一个由老龄网络和其他领导人组成的转化咨询委员会将帮助制定和指导国家COPE传播计划。研究目标：目标1.1：随机分组后4个月（4个月）确定COPE对功能依赖的影响。目的1.2：确定4个月时COPE对活动参与、生活质量和神经精神症状（NPS）的影响。目标1.3：确定COPE在12个月时对功能依赖、活动参与、生活质量和NPS的影响。研究目的：目的2.1：确定4个月时COPE对CG幸福感的影响。目的2.2：确定COPE对4个月时使用痴呆管理策略的信心的影响。目标2.3：在12个月时，确定COPE对CG感知幸福感、使用活动的信心和让病人在家的能力的影响。目标3.1：确定COPE的净经济效益，考虑COPE干预成本、CHCPE常规护理成本、养老院成本和其他服务成本，分别为4个月和12个月。目标3.2：从多个利益相关者的角度确定在CHCPE中实施COPE的可行性和可接受性。这项转化性研究将作为一个全国性的模型，用于在公共资助的家庭护理项目中嵌入和评估基于证据的服务，这些项目针对的是有进入养老院风险的老年痴呆症患者。

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.