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Statewide Implementation of CAPABLE-Community Aging in Place, Advancing Better Living for Elders in the Michigan Medicaid Home and Community Based Waiver Program

在全州范围内实施能力社区老龄化，促进密歇根州医疗补助家庭和社区豁免计划中老年人的更好生活

基本信息

批准号：
10117746
负责人：
Sandra Lee Spoelstra
金额：
$ 24.46万
依托单位：
GRAND VALLEY STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-15 至 2021-07-31
项目状态：
已结题

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly half of older adults report problems with function, which can lead to difficulty with activities of daily living and nursing home placement. Thus, there is a need to implement evidence-based models of care to improve function and those factors that support function in older adults living in the community. One such model is a person-centered, self-directed, nurse and occupational therapy intervention supported by assistive devices and home modifications. We build on current work that is implementing the model statewide in an R15 AREA 3- year, randomized, Hybrid-3, mixed trial. We extend this NIA-funded trial by addressing a problem found while deploying the model with beneficiaries with Alzheimer’s disease or dementia. There are 39.8 million informal caregivers in the US and 16.3 million who care for someone with Alzheimer’s disease or dementia; and 1,500 are in the Michigan waiver. Most beneficiaries with those conditions did not accept the model as they were unable to receive instruction. Our setting is Medicaid Home and Community Based Service waiver program sites (in the National Institutes of Aging funded parent trial 1 R15 AG058193-01A1, 9/1/2018-8/30/2021, ClinitalTrials.gov NCT03634033) in Michigan that care for community-dwelling disabled older adults. The goal of this Supplement is to extend provision of the model to waiver beneficiaries with Alzheimer’s disease or dementia via engagement of their informal caregivers. A 12-month phased project will occur. First, we will consult experts to refine our toolkit for use by informal caregivers so they can assist with delivery of the model to those with Alzheimer’s disease or dementia. Second, we will enroll 5 caregivers, assess age, sex, race, education, and relationship to beneficiary, provide the toolkit, and use an iterative process to refine the toolkit. Third, we will confirm and finalize toolkit content with experts. Fourth, after consent, we will assess clinician characteristics, train them in use of the toolkit, and examine knowledge uptake and satisfaction with training. Fifth, we will use a mixed method pre/post-design with a convenience sample of 60 caregivers and beneficiary’s dyad to examine acceptability, feasibility, and satisfaction with use of the toolkit. After consent, caregivers will be assessed for age, sex, race, education, self-efficacy, and relationship to beneficiary at baseline. After 1 month, the clinicians will provide the toolkit and the model will be deployed. Toolkit use will be examined for 3 months and at exit, we will assess caregiver self-efficacy and satisfaction with the toolkit. Finally, preliminary efficacy of an informal caregiver toolkit to support deployment of the model of care will be tested based on the beneficiary outcomes. This work will impact use of the model with informal caregivers of those with Alzheimer’s disease or dementia, to improve older adults’ outcomes in a Medicaid waiver program. This natural setting approach has high generalizability for waivers, as we learn what caregivers need to support use of the model of care with Alzheimer’s disease or dementia beneficiaries.

项目总结/摘要近一半的老年人报告功能问题，这可能导致日常生活活动困难和养老院安置因此，有必要实施循证护理模式，以改善功能和那些支持生活在社区的老年人的功能的因素。一个这样的模型是以人为本，自我指导，护士和职业治疗干预辅助设备的支持，家庭改造我们建立在目前的工作，是实施模型全州在一个R15区3- 年，随机化，Hybrid-3，混合试验。我们通过解决一个问题来扩展这个由NIA资助的试验，将该模型应用于患有阿尔茨海默病或痴呆症的受益人。有3980万非正式护理人员在美国和1630万谁照顾阿尔茨海默病或痴呆症的人;和1500 都在密歇根州的弃权书里大多数有这些条件的受益人并不接受现有的模式无法接受指令。我们的设置是Medicaid家庭和社区服务豁免计划研究中心（在美国国立老龄研究院资助的母试验1 R15 AG 058193 - 01 A1，2018年9月1日至2021年8月30日， ClinitalTrials.gov NCT 03634033），该机构在密歇根州为社区居住的残疾老年人提供护理。目标该补充的目的是将该模式的规定扩展到患有阿尔茨海默病的豁免受益人，或通过非正式护理人员的参与来治疗痴呆症。将进行为期12个月的分阶段项目。一是咨询专家，完善我们的工具包，供非正式护理人员使用，以便他们能够协助提供模型老年痴呆症或痴呆症患者。其次，我们将招募5名护理人员，评估年龄，性别，种族，教育和与受益人的关系，提供工具包，并使用迭代过程来完善工具包。第三，我们将与专家确认并最终确定工具包内容。第四，在同意后，我们将评估临床医生评估的目的是了解这些人员的特点，培训他们使用工具包，并检查他们的知识吸收情况和对培训的满意度。第五，我们将使用一个混合的方法前/后设计与方便样本的60名照顾者，受益人的二元结构，以审查可接受性、可行性和对工具包使用的满意度。同意后，将对护理人员的年龄、性别、种族、教育、自我效能和与受益人的关系进行评估，基线。1个月后，临床医生将提供工具包，并部署模型。工具包的使用将检查3个月，并在退出时，我们将评估照顾者的自我效能和满意度的工具包。最后，一个非正式的护理工具包，以支持护理模式的部署的初步效力将是根据受益人的结果进行测试。这项工作将影响该模型在非正式照顾者中的使用，那些患有阿尔茨海默病或痴呆症的人，以改善老年人在医疗补助豁免计划中的结果。这种自然环境的方法具有高度的普遍性豁免，因为我们了解什么照顾者需要支持对阿尔茨海默病或痴呆症受益人使用护理模式。