Building Resilience In SKilled nursing facilities (BRISK): Development and Pilot Testing of a Dyadic Intervention for Psychological Distress in Post-Acute Skilled Nursing Care

建立熟练护理设施的复原力（BRISK）：针对急性后熟练护理中心理困扰的二元干预措施的开发和试点测试

• 批准号: 10739279
• 负责人: Evan Plys
• 金额: $ 19.4万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10739279
• 关键词: Acute; Address; Adherence; Adoption; Anxiety; Area; Award; Care given by nurses; Caregivers; Caring; Chronic; Client satisfaction; Clinical; Clinical Trials; Communities; Conduct Clinical Trials; Coping Skills; Data; Development; Disparity; Dissemination and Implementation; Distress; Educational Status; Effectiveness; Elderly; Ensure; Environment; Equity; Evidence based intervention; Expectancy; Family; Feedback; Focus Groups; Foundations; Future; General Hospitals; Goals; Health; Health care facility; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hybrids; Individual; Intervention; Interview; Knowledge; Leadership; Long-Term Care; Massachusetts; Measures; Medical; Medicare/Medicaid; Mental Depression; Mentorship; Methods; Mission; Modeling; Modification; Nursing Homes; Outcome; Outcome Measure; Participant; Patient Care; Patients; Persons; Pilot Projects; Population; Program Evaluation; Protocols documentation; Psychological Stress; Questionnaires; Randomized; Randomized, Controlled Trials; Recovery; Rehabilitation therapy; Research; Research Design; Research Personnel; Research Support; Resources; Risk; Risk Reduction; Skilled Nursing Facilities; Statistical Data Interpretation; Stress; Structure; Surveys; System; Testing; Training; United States National Institutes of Health; Work; acceptability and feasibility; acute care; arm; beneficiary; care preference; career; coping; design; dual eligible; effectiveness trial; efficacy testing; experience; family management; feasibility testing; health disparity; health equity promotion; hospital readmission; improved; intergenerational; intervention refinement; medical schools; member; multidisciplinary; multiple chronic conditions; novel; nursing skill; older patient; patient oriented; pilot test; promote resilience; psychologic; psychological distress; psychological outcomes; psychological symptom; psychosocial; readmission rates; skill acquisition; skills; socioeconomic disadvantage; socioeconomics; stressor; telehealth; theories; therapy design; therapy development; treatment as usual

Background: The timing of a skilled nursing facility (SNF) stay is met with significant psychological stress for both patients and family care-partners (CPs), which can negatively impact recovery as well as long-term health and psychological outcomes. These consequences may be magnified among socioeconomically disadvantaged patients (i.e., dual-eligible beneficiaries) and their CPs, who experience multiple health disparities. Dyadic psychological interventions promote coping skills to improve short-term distress and reduce the risk of chronic psychological symptoms for both patients and CPs, but are untested in SNFs. To address this limitation and to progress the field toward improving psychological care in SNFs, I will develop and pilot “Building Resilience In SKilled nursing facilities” (BRISK), a dyadic intervention designed to reduce psychological distress among socioeconomically disadvantaged patients and CPs during a post-acute SNF stay. Specific aims and research design: (1) iteratively develop BRISK with multi-level stakeholder input by conducting semi-structured interviews with up to 20 patient-CP dyads and 4 focus groups with SNF clinical and leadership staff (NIH Model Stage 1a); (2) refine and optimize BRISK by conducting a single-arm open pilot study with 5 patient-CP dyads and exit interviews with 5 SNF staff (NIH Model Stage 1a); and (3) test the feasibility, acceptability, and fidelity of BRISK by conducting a pilot cluster randomized controlled trial with patient-CP dyads completing BRISK (N=30 dyads) or minimally enhanced usual care (N=20 dyads) in 3 SNFs (NIH Stage Model 1b). A diverse stakeholder advisory council will convene throughout the award period to collaboratively guide intervention development and refinements to enhance the relevance and real-world adoption potential of BRISK. Training: I have developed a rigorous training plan designed to support the research aims and end goal of this proposal, as well as help me launch my career as an independent patient-oriented investigator with the long-term career goal of improving psychological care for socioeconomically disadvantaged patients and families in SNFs. The specific training goals are to: (1) develop skills in intervention development and optimization; (2) acquire skills for clinical trials research, including statistical analysis, with dyads in SNFs; and (3) acquire skills for research with socioeconomically disadvantaged older adults and families, with the goal of promoting health equity. The research environments at Massachusetts General Hospital and Harvard Medical as well as my multidisciplinary mentorship team with distinct and complementary areas of expertise will help ensure the successful achievement of training goals. Impact: I am a clinical geropsychologist with expertise in residential post-acute and long-term care settings. My ultimate mission is to develop a feasible, scalable, and sustainable psychological intervention that improve care among dual-eligible patients and their CPs receiving post-acute SNF care. The research and training goals outlined in this K23 proposal will provide the foundation for future clinical trials to test the efficacy-effectiveness and, eventually, dissemination and implementation of BRISK with socioeconomically disadvantaged patient-CP dyads receiving post-acute care in SNFs, a high-need and under- studied population. This work is well aligned with NIA's goal of improving coping ability and reducing caregiver, family, and patient stress (Strategic Goal C; Objective C-4) with a NIA priority population.

背景：在专业护理机构（SNF）停留的时间对两名患者都有显著的心理压力 和家庭护理伙伴（CP），这可能会对恢复以及长期健康和心理健康产生负面影响。 结果。这些后果可能在社会经济上处于不利地位的患者中被放大（即，双重资格 受益人）及其接触者，他们经历着多重健康差距。双元心理干预促进应对 改善短期痛苦和降低患者和CP慢性心理症状风险的技能， 在SNF中没有测试过。为了解决这一局限性，并朝着改善SNF的心理护理的方向发展，我 将开发和试点“在熟练护理设施中建立复原力”（BRISK），这是一种旨在减少 在急性SNF后住院期间，社会经济弱势患者和CP的心理困扰。具体 目标和研究设计：（1）通过进行半结构化的 与SNF临床和领导人员一起采访最多20名患者-CP二元组和4个焦点小组（NIH模型阶段1a）; (2)通过对5个患者-CP配对和退出访谈进行单臂开放性试点研究，完善和优化BRISK 与5名SNF工作人员（NIH模型阶段1a）;（3）通过进行一项 完成BRISK（N=30对）或轻微增强的患者-CP对的试点群集随机对照试验 常规护理（N=20对）在3个SNF（NIH阶段模型1b）。一个多元化的利益相关者咨询理事会将在整个 奖励期，以协同指导干预措施的开发和改进，以提高相关性和现实世界 采用BRISK的潜力。培训：我制定了严格的培训计划，旨在支持研究目标 这一建议的最终目标，以及帮助我开始我的职业生涯作为一个独立的以病人为导向的调查与 长期的职业目标是改善对社会经济上处于不利地位的患者和家庭的心理护理。 具体的培训目标是：（1）发展干预开发和优化的技能;（2）获得以下技能： 临床试验研究，包括统计分析，在SNF中使用二元组;以及（3）获得研究技能， 在社会经济上处于不利地位的老年人和家庭，目标是促进保健公平。研究 我在马萨诸塞州总医院和哈佛医学院以及我的多学科导师团队的环境中， 具有独特且互补的专业知识领域将有助于确保成功实现培训目标。影响： 我是一名临床老年心理学家，在住宅急性和长期护理环境中具有专业知识。我的终极使命是 开发一种可行的、可扩展的、可持续的心理干预措施，改善双重资格患者的护理 以及接受急性SNF后护理的CP。本K23提案中概述的研究和培训目标将提供 为未来的临床试验奠定基础，以测试疗效-有效性，并最终传播和实施 BRISK与社会经济上处于不利地位的患者-CP二人组在SNF接受急性后护理，这是一种高需求和低需求 研究人口。这项工作与NIA提高应对能力和减少照顾者，家庭， 和患者压力（战略目标C;目标C-4）。