Technological Home Care: Improving Caregiving

描述（由申请人提供）：本研究的具体目的是测试护理干预（FamTechCare）对家庭照顾者解决问题能力、参与医疗保健管理、健康状况、抑郁、生活质量和医疗保健服务成本的影响。研究对象为家庭护理人员（n= 80）和80名因非恶性胃肠道疾病依赖家庭肠外营养（HPN）输注生存的成年患者。招聘是通过堪萨斯大学医院及其农村外展中心进行的。招生将在整个项目中错开，以确保足够的人数和代表性的性别和种族分布。研究方法包括安慰剂对照纵向临床试验设计，通过可视电话护士访问、基于互联网的家庭护理算法指导和同伴支持提供交叉干预。同伴是具有丰富的HPN经验的家庭护理人员，他们将接受培训，通过视频电话指导二人组。这些FamTechCare干预措施基于广泛的初步数据，并为本研究提供了新的创新扩展。整个干预措施进行了试点测试，发现是可行的，不是负担。用于获得干预前后数据的问卷调查和实验室数据是有效的，对变化敏感且可靠的，并且在中试期间平均在20分钟内完成。数据分析将包括嵌套线性混合模型假设检验，以检测对护理者/患者的影响。通过网络传播的新型护理理念也得到了验证。传统的成本分析和创新的数据包络分析（DEA）将用于描述每个家庭的家庭护理效率与卫生服务成本的关系。这项研究使用视频电话和互联网传输，增加了医疗保健的可及性，减少了医疗保健的差距。潜在意义和长期目标是加强家庭护理技能，改善健康状况，生活质量和自我管理慢性疾病症状和侵入性家庭护理治疗。

DESCRIPTION (provided by applicant): Specific aims of this study are to test the effects of a nursing intervention (FamTechCare) on family caregivers' problem solving ability, participation in health care management, health status, depression, quality of life, and health care services costs. Subjects in the study will be family caregivers (n= 80) and 80 adult patients dependent for survival on Home Parenteral Nutrition (HPN) infusions due to nonmalignant gastrointestinal disorders. Recruitment is through Kansas University Hospital and its rural outreach centers. Enrollment will be staggered over the project in order to assure adequate numbers and representative gender and racial distributions. Research methods include a placebo-controlled longitudinal clinical trial design with crossover and interventions delivered by videophone nurse visits, internet-based home care algorithm guides and by peer support. Peers are family caregivers with extensive HPN experience who will be trained to mentor dyads via videophone. These FamTechCare interventions are based on extensive preliminary data and include new, innovative extensions for this study. The entire intervention was pilot- tested and found feasible and not a burden. Questionnaires and laboratory data used to obtain pre- and post-intervention data are valid, sensitive to change and reliable and were completed in an average 20 minutes during pilot testing. Data analyses will include nested linear mixed model hypothesis testing to detect effects on caregiver/patient dyads. The novel concept of nurse caring conveyed via internet is also tested. Traditional cost analysis and the, innovative Data Envelopment Analysis (DEA) will be used to describe each family's home care efficiency in relation to and health services costs. This study uses videophone and internet delivery which increases health care access and reduces health care disparities. The potential significance and the long term goals are to strengthen home caregiving skills, improve health status, quality of life and self-management of chronic illness symptoms and invasive home care treatment.