Implementation of EIT-4-BPSD in Nursing Homes

摘要 痴呆症的行为和心理症状（BPSD）包括攻击性，激动，抑郁， 焦虑，冷漠和幻觉，并表现出高达90%的养老院居民与痴呆症。 对于居民来说，BPSD会导致负面的健康结果，身体功能下降， 增加抗精神病药物（AP）和身体限制的不适当使用。私营部门司还为 长期护理费用高。我们和其他研究人员已经证明，行为方法可以减少 BPSD。医疗保险和医疗补助服务中心（CMS）在其国家合作伙伴关系，以改善 老年痴呆症护理和减少抗精神病药物在疗养院的使用现在集中在监管工作， 关于确保以人为本为痴呆症患者提供护理的疗养院调查 行为方法以人为本的护理侧重于个人之间的合作伙伴关系， 他们的家庭和提供者，并强调健康和福祉，对个人的 优先事项、目标和需求。不幸的是，只有不到2%的养老院实施了这些变化。 使用行为方法的主要障碍是工作人员的知识、技能和动力有限， 利用这些方法。拟议的研究回应了实施以人为本的需要， 一种通过测试BPSD的循证实践来管理BPSD的方法， 证据整合三角（Evidence Integration Triangle，EIT）。我们与CMS合作， 推进国家伙伴关系，并编制了一份全面的同行审查/专家审查汇编， 认可的资源，用于利用以人为本的行为方法来实现BPSD（即，养老院 Toolkit; nursinghometoolkit.com）。促进以人为本的行为管理的实施 在BPSD中，我们合并了工具包和我们之前测试的4步方法，以克服障碍 执行。步骤包括：步骤1.环境和政策评估;步骤2。教育 工作人员;步骤3。建立以人为本的护理计划;步骤4。指导和激励员工）， 开发EIT-4- BPSD的EIT实施策略。我们提出了一个随机分组试验， 养老院随机分为EIT-4-BPSD或仅教育（EO）。我们的目标是：1：实施和测试 EIT-4-BPSD; 2：评估EIT战略的使用情况以及我们与员工的参与式实施过程。 这项研究的结果将增加什么是已知的实施有效的干预护理 家庭，将作为其他计划和护理方法的典范，并将帮助设施和工作人员 实施以人为本的优质护理，这是国家伙伴关系的最终目标。

Abstract Behavioral and Psychological Symptoms of Dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home residents with dementia. For residents, BPSD contribute to negative health outcomes, a decline in physical functioning, and may increase the inappropriate use of antipsychotic drugs (AP) and physical restraints. BPSD also contribute to the high cost of long term care. We, and other researchers, have shown that behavioral approaches can reduce BPSD. The Centers for Medicare and Medicaid Services (CMS) in their National Partnership to Improve Dementia Care and Reduce Antipsychotic Use in Nursing Homes has now focused regulatory efforts during the nursing home survey on ensuring that care for residents with dementia is delivered using person-centered behavioral approaches. Person-centered care is focused on collaborative partnerships among individuals, their families and providers and emphasizes health and well-being by being responsive to an individual's priorities, goals and needs. Unfortunately, less than 2% of nursing homes have implemented these changes. The major barriers to use of behavioral approaches are limited knowledge, skills and motivation of staff to utilize these approaches. The proposed research responds to the need to implement a person-centered approach to management of BPSD by testing evidence-based practice for BPSD under conditions of an implementation strategy referred to as the Evidence Integration Triangle (EIT). We worked with CMS to advance the National Partnership and developed a comprehensive compendium of peer-reviewed/expert- endorsed resources for utilizing person-centered, behavioral approaches to BPSD (i.e., a Nursing Home Toolkit; nursinghometoolkit.com). To facilitate implementation of the person-centered behavioral management of BPSD we merged the Toolkit and our previously tested 4-step approach as a way to overcome the barriers to implementation. The steps include: Step 1. Assessment of the Environment and Policies; Step 2. Education of Staff; Step 3. Establishing Person Centered Care Plans; and Step 4. Mentoring and Motivating of Staff) with the EIT implementation strategy to develop the EIT-4- BPSD. We propose a cluster randomized trial with 50 nursing homes randomized to EIT-4-BPSD or Education Only (EO). Our aims are to: 1: implement and test EIT-4-BPSD; and 2: evaluate use of the EIT strategy and our participatory implementation process with staff. The findings from this study will add to what is known about implementation of effective interventions in nursing homes, will serve as a model for other programs and care approaches, and will help facilities and staff implement quality person-centered care, the ultimate goal of the National Partnership.