The Role of Visit Audio Recordings in Triadic Dementia Care

探访录音在三元痴呆护理中的作用

• 批准号: 10620802
• 负责人: PAUL JAMES BARR
• 金额: $ 81.09万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10620802
• 关键词: Accountability; Address; Adherence; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care Facilities; Behavior; Caring; Clinic Visits; Clinical; Communication; Communities; Computer software; Data; Decision Making; Dementia; Effectiveness; Emotional; Ethnic Origin; Exclusion; Family; Federally Qualified Health Center; Feedback; Funding; Future; Geography; Goals; Health; Health Services; Intervention; Interview; Knowledge; Lebanon; Linguistics; Maps; Methods; Modeling; Motivation; Natural Language Processing; Observational Study; Outcome; Patient Care; Patient Preferences; Patients; Performance; Personal Communication; Persons; Play; Primary Care; Process; Provider; Quality of life; Race; Readiness; Recommendation; Reporting; Research; Resources; Role; Roter; Sampling; Schedule; Site; Structure; System; Systems Analysis; Techniques; Trust; United States National Institutes of Health; Visit; Work; acceptability and feasibility; aged; arm; behavior change; behavior change wheel; cognitive load; dementia care; design; evidence base; experience; follow-up; human old age (65+); improved; improved outcome; information processing; innovation; novel; open label; pilot trial; primary care clinic; prospective; psychosocial; rural health clinic; satisfaction; skills; software development; theories; therapy design; tool; trustworthiness; usability

PROJECT SUMMARY One in nine people aged 65 or older in the US lives with Alzheimer's disease (AD) or Alzheimer's disease-related dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits for dementia information, management, and community referrals. Quality interpersonal communication is associated with improved health-related outcomes. Models of triadic interactions purport that information exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to effective interpersonal communication. However, the degree to which effective interpersonal communication is achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application is unexplored in dementia. The objective of this proposal is to design an intervention that enhances interpersonal communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their visit recording platform, HealthPAL, which leverages natural language processing to structure visit information. The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of 200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD. Applicants hypothesize: 1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2) HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for behavior change will be identified using quantitative assessment of interpersonal communication during triadic visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on interpersonal communication in triadic AD/ADRD visits. This work is a necessary first step to improving PLWD triadic care by identifying behaviors that impact interpersonal communication and their associations with health- related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.

项目总结