Training to Improve Late-Stage Dementia Care

描述(申请人提供)：阿尔茨海默病和相关痴呆症(ADRD)结合在一起，构成了21世纪美国老龄化人口面临的紧迫医疗挑战。在美国，2008年，每71秒就有一人被诊断为ADRD；到2050年，这个数字将达到每33秒一例。在本申请报告正文中引用的当局ADRD是美国第三昂贵的疾病集。尽管正在进行研究努力，目前还没有办法防止ADRD的发病，死亡是唯一确定的治疗方法。护理选择是复杂的，因为晚期ADRD患者的认知和身体衰退对每个人来说都不同，而且没有任何单一的护理程序或方案可以预测到有效。此外，与晚期ADRD护理相关的挑战给注册护士助理(CNA)带来了巨大的压力和更大的负担。许多医务主任和其他ADRD机构的专业人员往往缺乏准备或时间来回应CNA在管理晚期ADRD患者护理方面的帮助请求。然而，在ADRD护理方面经验丰富的各权威机构表示，当CNA接受这一领域的持续教育和技能培训时，会产生可衡量的积极影响。因此，这一第二阶段的工作旨在教育CNA有效照顾ADRD下降晚期患者所需的知识和技能，并通过一个创新的、基于互联网的培训计划来做到这一点，该培训计划提供10个专题模块小时的具有挑战性的、信息性的、基于应用的课程。该产品超越了传统被动的CNA教育和在职培训方法，转而提供多媒体功能，如采访、护理模型、真实流媒体视频和在线互动。通过这一培训计划，CNAS可以方便地、全天候、私下接触整个干预顾问团队和在管理晚期ADRD相关护理方面经验丰富的治疗支持专家。改进的CNA做法的分散效果也可能促进多层次的干预，有能力以许多积极的方式影响护理接受者本身及其亲人。除了其强大的商业潜力外，拟议的第二阶段培训产品还能够在长期护理设施、辅助生活设施、社区大学、军队和退伍军人医院和服务、医务室、医疗机构以及农村和城市医疗机构等各种场所惠及公共卫生。在第二阶段，随机对照试验(RCT)将测试已完成干预的有效性，第三阶段将进行商业化。鉴于申请组织与阿尔茨海默氏症协会全国办公室的合作，这一努力的所有阶段的平行好处之一很可能是减少ADRD给美国医疗保健系统带来的直接和间接成本。 公共卫生相关性：拟议的努力与国家公共健康相关，因为在2008年，520万所有年龄段的美国人患有阿尔茨海默病和相关痴呆(ADRD)，这意味着每71秒就有一例ADRD诊断(阿尔茨海默病事实和数据，2008年，第8页)。ADRD的经济成本包括1480亿美元的联邦医疗保险和医疗补助的直接成本(不包括退伍军人事务部支付的成本、私人医疗保健和长期护理保险)，以及估计为国家医疗系统节省的2670亿美元，因为980万家庭成员为患有ADRD的人提供至少70%的在家护理而不是在养老院报销。此外，晚期ADRD护理与照料者的心理社会成本密切相关，照顾者必须直接对以晚期痴呆症为特征的认知衰退的居民作出反应(阿尔茨海默病事实和数据，2008年)。

DESCRIPTION (provided by applicant): Alzheimer's disease and related dementias (ADRD) combine to form an urgent healthcare challenge facing the aging population of 21st Century America. In the U.S. during 2008, one person received an ADRD diagnosis every 71 seconds; by 2050, that number will be one every 33 seconds. Authorities cited in the body of this application report ADRD are the third most costly disease sets in the U.S. In spite of ongoing research efforts, at present there is no way to prevent onset of ADRD, and death is the only certain cure. Caregiving options are complicated because the cognitive and physical declines of those with late-stage ADRD differ for each person, and no single care routine or protocol is predictably effective. Further, the challenges associated with late-stage ADRD care cause immense stress and increased burden to Certified Nursing Assistants (CNAs). Many medical directors and other ADRD facility professionals often lack either the preparation or the time to respond to CNAs' requests for help in managing patient care with those in late-stage ADRDs. Various authorities experienced in ADRD care, however, suggest measurable positive effects result when CNAs receive ongoing education and skill training in this area. This Phase II effort aims therefore to educate CNAs in the knowledge and skills they need to care effectively for those in late-stage ADRD decline and to do so through an innovative, Internet-based training program presenting 10 topical module hours of challenging, informative, application-based curriculum. This product exceeds traditional passive methods of CNA education and in-service training and provides instead multi-media features such as interviews, care models, real-life streaming videos, and online interaction. Through this training program, CNAs gain convenient, 24/7, private access to an entire team of intervention consultants and therapeutic support specialists experienced in managing late-stage ADRD-related care. The dispersed effects of improved CNA practice may also facilitate a multi-level intervention with power to affect in many positive ways the care recipients themselves as well as their loved ones. In addition to its strong commercial potential, the proposed Phase II training product has the capacity to benefit public health in venues as diverse as long-term care facilities, assisted-living facilities, community colleges, military and veterans' hospitals and services, medical offices, healthcare agencies, and both rural and urban healthcare settings. During Phase II, a randomized controlled trial (RCT) will test efficacy of the completed intervention, and commercialization will be undertaken during Phase III. Given the applicant organization's collaboration with the national office of the Alzheimer's Association, one of the parallel benefits of all phases of this effort may well be the reduction of both direct and indirect costs of ADRD to U.S. health care systems. PUBLIC HEALTH RELEVANCE: The proposed effort is relevant to the nation's public health because during 2008, 5.2 million Americans of all ages have Alzheimer's disease and related dementias (ADRD), which translates to one ADRD diagnosis every 71 seconds (Alzheimer's Disease Facts and Figures, 2008, p. 8). The economic cost of ADRD includes $148 billion in direct costs to Medicare and Medicaid (not including the costs paid for by the Department of Veterans' Affairs, private health care, and long-term care insurance), and an estimated $267 billion savings to the national healthcare system because 9.8 million family members deliver at least 70 percent of the care for those with ADRD at home without reimbursement instead of in nursing homes. Further, late-stage ADRD care is strongly associated with psychosocial costs to caregivers, who must respond directly to residents in the cognitive declines characteristic of late-stage dementia (Alzheimer's Disease Facts and Figures, 2008).