Low Literacy Elder Caregiver Support for Call Centers

描述(由申请人提供)：由于大多数联邦医疗保险支出涉及因慢性心力衰竭和慢性阻塞性肺病等慢性疾病反复住院，而且往往是可以预防的，私营部门的疾病管理组织越来越多地向患有这些疾病的老年人提供电话支持。为了改善护理协调，呼叫中心教练需要材料来帮助老年照顾者扮演患者和他们自己的坚持促进者的角色。该项目将开发和评估一个基于网络的多级内容交付系统，以：(A)就照顾者问题对呼叫中心教练进行培训，(B)促进教练员对照顾者具体需求的评估，以及(C)以各种格式(DVD-视频、四年级阅读水平印刷品和PDF)为照顾者征用量身定制的低识字率后续媒体。该系统将与现有的呼叫中心应用程序集成，以帮助教练解决疾病管理、护理计划遵守、个人应对护理者角色和护理者自我护理等领域。在第一阶段，该项目将侧重于充血性心力衰竭(CHF)患者的照顾者；在第二阶段，重点将扩大到包括慢性阻塞性肺疾病(COPD)患者的照顾者。本修订申请是对美国国立卫生研究院宣布恢复法案资金可用于竞争性修订申请(NOT-OD-09-058)的回应。它直接涉及：(A)ARRA立法的目标，以及(B)家长第一阶段申请审查员的主要关切：“最突出的限制是，评估研究没有真正评估干预的主要和最有希望的组成部分--呼叫中心互动和指导。”家长第一阶段的申请包括制作和评估有关慢性心力衰竭的照顾者教育材料。为了回应审查者的关注，这个修订阶段I应用程序将创建和评估系统的补充培训和指导组件的原型。因此，该项目将通过测试两个方案组成部分的可行性来加速研究，使第二阶段应用的审查员能够更清楚地评估整个方案的可行性。此外，这一修订将提供相当大的ARRA资金，以支持兼职/资助不足的研究人员。原型呼叫中心组件的有效性将由40名呼叫中心教练使用受试者内的事前后测试设计进行评估。结果包括知识自我效能感、动机、感知效用和用户满意度。在母项目和修订项目的第一阶段中吸取的经验教训将在第二阶段得到应用，从而提高方案的质量。第二阶段将把护理者材料扩展到所有领域，增加关于慢性阻塞性肺病和护理者自我护理/应对的护理者和呼叫中心材料，以及产品宣传材料。在第二阶段，整个计划将接受一项涉及老年照顾者的大规模随机临床试验，以及对呼叫中心工作人员的过程和结果评估。 公共卫生相关性：老年护理员是卫生保健团队不可或缺的一部分，促进护理计划的遵守并使其能够独立生活。此外，作为老年人本身，他们也面临着自己的健康挑战，而他们的照看角色往往加剧了这一挑战。该计划旨在帮助疾病管理呼叫中心教练在疾病管理技能、护理计划遵从性、照顾者应对和照顾者自我护理方面为老年照顾者提供最先进的支持，包括通过DVD视频、硬拷贝或电子邮件文章提供的低识字率跟踪材料。

DESCRIPTION (provided by applicant): Because the majority of Medicare expenditures involve repeated and often preventable hospitalizations for chronic conditions like CHF and COPD, private-sector disease management organizations are increasingly offering telephonic support to seniors with these conditions. In order to improve care coordination, call center coaches need materials to help elder caregivers in their roles as adherence facilitators for both the patient and themselves. This project will develop and evaluate a multi-level Web-based content delivery system to: (a) train call center coaches on caregiver issues, (b) facilitate coaches' assessment of caregiver-specific needs, and (c) requisition tailored low-literacy follow-up media for the caregiver in a variety of formats (DVD-video, 4th grade reading level print and PDF). The system will integrate with existing call center applications to help coaches address the domains of disease management, care plan adherence, personal coping with the caregiver role, and caregiver self-care. In Phase I, this project will focus on caregivers of individuals with Congestive Heart Failure (CHF); in Phase II the focus will be expanded to include caregivers of individuals with Chronic Obstructive Pulmonary Disorder (COPD). This revision application is submitted in response to NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (NOT-OD-09-058). It directly addresses: (a) the goals of the ARRA legislation, and (b) the primary concern of the parent Phase I application reviewers: " "The most salient limitation is that the evaluation study does not really assess the main and most promising component of the intervention - the call center interactions and coaching." The parent Phase I application involves the production and evaluation of caregiver educational materials on CHF. In response to reviewer concerns, this revision Phase I application will create and evaluate a prototype of the system's complementary training and coaching components. Thus, this project will accelerate the research by testing the feasibility of both program components, allowing reviewers of the Phase II application to more clearly assess the feasibility of the overall program. In addition, this revision will provide considerable ARRA funding to support part-time/under-supported research personnel. The efficacy of the prototype call center component will be evaluated with 40 call center coaches using a within-subject pre-post test design. Outcomes include knowledge self-efficacy, motivation, perceived utility, and user satisfaction. Lessons learned in Phase I of both the parent and revision projects will be applied in Phase II, improving the quality of the program. Phase II will expand the caregiver materials to cover all domains, adding caregiver and call center materials on COPD and caregiver self-care/coping, as well as product promotional materials. In Phase II, the complete program will undergo a large-scale randomized clinical trial involving elder caregivers, and a process and outcome evaluation of the call center staff. PUBLIC HEALTH RELEVANCE: Elder caregivers are an integral part of the health care team, facilitating care plan adherence and enabling independent living. In addition, as seniors themselves, they have their own health challenges, which are often exacerbated by their caregiving role. This program is designed to assist disease management call center coaches in offering state-of-the-art support to elder caregivers in the domains of disease management skills, care plan adherence, caregiver coping, and caregiver self-care, including low literacy follow-up materials available on DVD-video, or as hard copy or e-mail articles.