Changing Talk Online (CHATO): A Pragmatic Trial to Reduce Behavioral Symptoms in Dementia Care

在线改变谈话（CHATO）：减少痴呆症护理中行为症状的务实试验

• 批准号: 9788216
• 负责人: KRISTINE N. WILLIAMS
• 金额: $ 13.62万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788216
• 关键词: Address; Administrator; Adult; Aggressive behavior; Alzheimer' s Disease; Antipsychotic Agents; Bathing; Behavior; Behavior Control; Behavior Therapy; Behavioral; Behavioral Symptoms; Caring; Clinical; Clinical trial protocol document; Code; Cognitive; Communication; Control Groups; Data; Data Collection; Data Set; Dementia; Dependence; Diagnosis; Education; Enrollment; Evidence based practice; Exhibits; Feedback; Goals; Home Nursing Care; Honey; Improve Access; Incentives; Individual; Injury; Institutional Review Boards; Internet; Intervention; Manuals; Measures; Modeling; Monitor; Motivation; Natural Language Processing; Nursing Homes; Persons; Pharmaceutical Preparations; Phase; Population; Pragmatic clinical trial; Preparation; Protocols documentation; Psycholinguistics; Quality of Care; Quality of life; Randomized; Research; Research Personnel; Rural; Services; Site; Speech; Stress; Symptoms; Testing; Time; Training; Training Programs; Training Support; Translations; United States Centers for Medicare and Medicaid Services; Withdrawal; base; care providers; cost; data management; dementia care; design; empowered; evidence base; improved; innovation; operation; performance site; post intervention; pragmatic trial; programs; psychological symptom; psychosocial; recruit; response; side effect; skills; tool

ABSTRACT The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use “elderspeak,” speech similar to baby talk that is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and better communication strategies and is proven to reduce staff elderspeak and BPSD in NH residents. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. CHAT training Online (CHATO) can improve access for busy staff and those in rural and small NHs to increase dissemination across care settings to improve dementia care. This R61/R33 study will develop and conduct a pragmatic clinical trial in response to PAR-18-585, Pragmatic Trials for Dementia Care I Long-term Services and Support (LTSS) Settings. We will test the effects of CHATO training on resident BPSD and psychotropic medication use in 120 NHs. In the R61 planning phase we will pilot test the online modules with NH staff to establish effects; recruit NH sites for the R33 trial; develop the clinical trial protocol, manual of operations, and data forms; develop data management, sharing, and fidelity assurance protocols; and obtain IRB approvals. A panel of NH administrators and staff will advise the team on recruitment strategies and a natural processing elderspeak feedback app will be tested in the clinical setting. In R33 phase we will conduct the pragmatic trial in 120 NHs that will be randomly assigned to CHATO training or to the control group. BPSD and psychotropic medication rate data, extracted from the Center for Medicare and Medicaid Services Nursing Home Compare and Minimum Data Set, will be compared using linear mixed modeling. NH strategies used to engage staff in CHATO (paid time off, recognition) and costs will be identified. The effects of a self-monitoring app that uses natural language processing to give staff immediate feedback on their elderspeak use will be tested. This research addresses NIA's milestones for nonpharmacological dementia care interventions, the National Plan to Address Alzheimer's Disease goal to enhance care quality and efficiency, and the Alzheimer's Association Plan to build a workforce with high-quality care skills. The goal of reducing inappropriate use of psychoactive medications to control BPSD using this nonpharmacological approach aligns with the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons diagnosed with dementia triples in the next 30 years, empowering care providers to provide high quality care for individuals with dementia is of critical importance.

摘要 不断增长的痴呆症人口对提供高质量的护理提出了挑战 家庭(NH)护理。痴呆症的行为和心理社会症状(BPSD)使护理复杂化，例如 痴呆症患者丧失认知能力时出现的攻击性、发声、走神和退缩 和沟通能力，不能用语言表达未得到满足的身体和心理社会需求。NH员工 使用“长辈话”，类似于婴儿说话，是对居民的贬低。居民对老年人讲话的反应 随着BPSD导致更多地使用精神药物来控制BPSD，更高的人员需求，更多 员工压力大，人员流失率高，成本增加。Change Talk(Chat)培训计划教育员工 关于长辈语言和更好的沟通策略，事实证明，它可以减少员工的长辈语言和BPSD NH居民。要提高这种基于课堂的有效培训的影响，下一步是测试聊天 在线互联网模块中提供的内容。在线聊天培训(CHATO)可以改善繁忙员工的访问 以及农村和小型NHS中的那些人，以增加在护理环境中的传播，以改善痴呆症的护理。 这项R61/R33研究将开发和进行针对PAR-18-585的务实临床试验， 痴呆症护理I长期服务和支持(LTSS)设置的实用试验。我们将测试其效果 在120个国家医疗服务体系中，提供查托住院医师BPSD和精神药物使用方面的培训。在R61规划阶段 我们将与NH工作人员一起试行测试在线模块以建立效果；为R33试验招募NH站点；开发 临床试验方案、操作手册和数据表单；开发数据管理、共享和保真度 保证协议；并获得IRB的批准。由NH管理员和工作人员组成的小组将就以下事项向团队提供建议 招募策略和自然处理的老年人语言反馈应用程序将在临床环境中进行测试。 在R33阶段，我们将在随机分配给Chato的120个NHS中进行务实试验 训练组或对照组。BPSD和精神药物用药率数据，摘自 Medicare和Medicaid Services养老院比较和最小数据集，将使用 线性混合建模。用于在Chato(带薪休假、认可)和成本方面聘用员工的NH战略将 被指认出来。使用自然语言处理的自我监控应用程序的效果可以为员工提供即时 将对他们使用老年人语言的反馈进行测试。这项研究阐述了NIA的里程碑 非药物痴呆症护理干预，解决阿尔茨海默病国家计划的目标是 提升护理质量和效率，阿尔茨海默病协会计划建设一支高素质的劳动力队伍 护理技能。减少不适当使用精神活性药物以控制bpsd的目标是使用 非药物方法符合改善痴呆症国家伙伴关系的首要目标 关心。随着未来30年被诊断为痴呆症的人数增加两倍，赋权护理 提供者为痴呆症患者提供高质量的护理至关重要。