Hospital GamePlan4Care: A Web-Based Delivery System for Dementia Caregiver Support

这是一个在阿尔茨海默病和相关痴呆症（ADRD）指导医生科学家奖 申请莫莉霍斯特曼博士，医院和卫生服务研究员在迈克尔E。德贝基弗吉尼亚州 医学中心，谁是建立自己作为一个年轻的调查员在医院医学的交叉， 痴呆和痴呆该奖项将为霍斯特曼博士提供必要的支持（1）开发 ADRD和痴呆症治疗方面的专业知识，（2）接受实施科学研究方面的正式培训 方法，和（3）获得经验需要建立自己作为一个独立的医生，科学家。到 为了实现这些目标，霍斯特曼博士组建了一个多学科的指导团队， ADRD，痴呆症护理，老年病学和实施科学研究方法的研究人员。 住院是ADRD退伍军人及其家庭照顾者的哨兵事件。成人 ADRD患者出院后通常会出现新的功能和认知限制， 出院后对家庭照顾者的要求。这些不断变化的护理人员需求增加了护理人员 压力，这可能导致照顾者和被照顾者的更糟糕的结果。经过20多年的研究 研究表明，在医院开始的护理过渡干预可以改善患者的预后。 此外，护理过渡干预措施始于医院，专门为满足需求而设计。 的中风照顾者已被证明可以减轻照顾者的负担和焦虑，并减少急性护理资源 出院后使用。迄今为止，这一证据基础支持量身定制的干预措施，以满足特定的 照顾者的需求尚未转化为在照顾过渡期间对痴呆症照顾者的支持。 提高阿尔茨海默氏症护理人员健康的资源（REACH II）是一个多方面的，以证据为基础的 ADRD护理人员支持计划已在退伍军人健康中调整和实施 作为REACH VA给药。当在社区交付时，REACH II和REACH VA相关联 照顾者抑郁、照顾者社会支持和照顾者自我照顾的改善， 照顾者的负担和问题行为在照顾接受者。循证干预措施，如REACH II， 由于护理人员之间需要一对一的互动， 痴呆症护理专家进行技能培训。GamePlan4Care（GP4C）是一个新颖的基于网络的培训平台 旨在通过可接受和可扩展的在线平台完全复制REACH II的核心组件 以用户为中心的测试。随着适应医院环境，包括护理过渡培训， GP4C具有很大的潜力，可以在护理过渡期间改变ADRD护理人员的支持。 该提案将联合收割机证据知情的护理过渡培训与现有的痴呆症护理人员相结合 支持干预，创造一个新的和独特的干预：医院GP4C。使用有计划的适应 方法，我们将建立在现有的GP4C平台，以纳入量身定制的强大证据支持 护理过渡培训和支持。目的是：1）使GP4C适应医院护理（医院GP4C），2） 评估医院GP4C干预的可行性和可接受性，以及3）评估护理人员- 在一项医院GP4C与健康对照的试点随机研究中报告了结局和保留率 教育在目标1中，将使用对护理人员和工作人员的半结构化访谈， 将GP4C用于医院护理。以人为本的设计将用于制定特定的护理过渡 内容，以补充现有的GP4C内容。在目标2中，将收集定量和定性数据， 评估医院GP4C的可行性和可接受性。在目标3中，一项单中心初步随机研究， 将医院GP4C与健康教育对照进行比较。护理员将在 医院该奖项的结果将通知VA优秀奖的多中心随机对照试验， GP4C医院

This is a Mentored Physician-Scientist Award in Alzheimer’s Disease and Related Dementias (ADRD) application for Dr. Molly Horstman, a hospitalist and health services researcher at the Michael E. DeBakey VA Medical Center, who is establishing herself as a young investigator at the intersection of hospital medicine, dementia, and caregiving. This award will provide Dr. Horstman with the necessary support (1) to develop expertise in ADRD and dementia caregiving, (2) to receive formal training in implementation science research methods, and (3) to gain the experience needed to establish herself as an independent physician-scientist. To achieve these goals, Dr. Horstman has assembled a multidisciplinary mentoring team of nationally recognized investigators in ADRD, Dementia Caregiving, Geriatrics, and Implementation Science research methods. Hospital admissions are sentinel events for Veterans with ADRD and their family caregivers. Adults with ADRD are often discharged from the hospital with new functional and cognitive limitations, which increases demands on family caregivers following discharge. These changing caregiver demands increase caregiver stress, which can lead to worse outcomes for caregivers and care recipients. Over 20 years of research has demonstrated that care transitions interventions started in the hospital can improve outcomes for patients. Furthermore, care transitions interventions started in the hospital and designed specifically to meet the needs of stroke caregivers have been shown to reduce caregiver burden and anxiety and reduce acute care resource use following discharge. To date, this evidence base supporting tailored interventions to meet specific caregiver needs has not been translated to the support for dementia caregivers during care transitions. Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) is a multicomponent, evidence-based ADRD caregiver support program that has been adapted and implemented in the Veterans Health Administration as REACH VA. When delivered in the community, REACH II and REACH VA were associated with improvements in caregiver depression, caregiver social support, and caregiver self-care and a decrease in caregiver burden and problem behaviors in the care recipient. Evidence-based interventions, like REACH II, are challenging to scale and spread due to the need for one-on-one interactions between caregivers and dementia care specialists for skills training. GamePlan4Care (GP4C) is a novel, web-based training platform designed to fully replicate the core components of REACH II in an acceptable and scalable online platform informed by user-centered testing. With adaptation to the hospital setting to include care transitions training, GP4C has great potential to transform the support of ADRD caregivers during care transitions. This proposal will combine evidence-informed care transitions training with an existing dementia caregiver support intervention to create a new and unique intervention: Hospital GP4C. Using a Planned Adaptation Approach, we will build on the existing GP4C platform to incorporate the robust evidence supporting tailored care transitions training and support. The aims are to: 1) adapt GP4C for hospital care (Hospital GP4C), 2) evaluate the feasibility and acceptability of the Hospital GP4C intervention, and 3) to evaluate caregiver- reported outcomes and retention rates in a pilot randomized study of Hospital GP4C compared to health education. In Aim 1, semi-structured interviews with caregivers and staff will be used to inform the planned adaptation of GP4C for hospital care. Human-centered design will be used to develop care transitions specific content to supplement existing GP4C content. In Aim 2, quantitative and qualitative data will be collected to assess the feasibility and acceptability of Hospital GP4C. In Aim 3, a single site pilot randomized study of Hospital GP4C compared to a health education control will be conducted. Caregivers will be recruited in the hospital. The results of this award will inform a VA Merit Award for a multisite randomized controlled trial of Hospital GP4C.