Improving Serious Mental Illness Care in Nursing Homes

描述(申请人提供)：照顾患有严重精神疾病(SMI)的居民是一个影响全国每个疗养院的问题。最近的研究表明，患有严重精神疾病的个人约占所有疗养院居民(超过15万人)的10%，这还不包括那些病情较轻的精神疾病患者、居住在辅助生活设施中的患者或在家中接受护理的患者。不幸的是，研究还表明，疗养院工作人员经常感到准备不足，无法满足这一群体独特的心理健康需求，而且文献中有证据表明，需要更多的工作人员培训。在第一阶段，研究人员将开发一种基于互联网的SMI培训干预方法，采用最先进的教学方法。将召集一个由国家专家组成的团队来指导这一过程，特别是在区分患有SMI的居民的行为问题与痴呆症患者的行为问题既相似又不同方面。在第一阶段和第二阶段期间，将开发十个计划模块，解决常见的行为问题，如何以文化敏感的方式向这一人群提供护理，以及如何与正式和非正式照顾者合作，以实现更好的精神健康和健康结果。完成的第一阶段干预将由注册护士助理在有限的随机对照试验(RCT)中进行评估。作为第一阶段实验设计研究的一部分，将进行事前、事后的定量和定性分析。这些发现将为第二阶段的研究和开发提供信息。调查人员预计，这一努力的结果是一套三个可商业化的模块，将改善生活在养老院环境中的SMI患者的护理质量和生活质量。 公共卫生相关性：叙事10%的疗养院(NH)居民患有严重的精神疾病(SMI)，这一群体经常过度使用昂贵的服务，如医院紧急护理、公共卫生承诺程序，以及频繁地往返NHS，在这些服务中，他们可能经常过度用药，不幸的是，行为管理策略并不经常使用(Christy&Molinari提交)。由于注册护士助理(CNA)报告称，对于管理患有SMI的住院医生的护理和行为感到培训不足，并且感到恐惧，因此，这项拟议的干预措施通过教育CNA了解SMI和适当的护理策略来解决这些广泛的公共卫生问题。调查人员在提案中的计算显示，如果将这一干预措施作为国家培训标准采用，在单一的NH设施实施这种干预措施每年可以节省数万美元，有可能在全国范围内降低与SMI相关的公共卫生成本，每年超过9亿美元。

DESCRIPTION (provided by applicant): Abstract Caring for residents with Severe Mental Illness (SMI) is an issue that impacts every nursing home in the country. Recent research indicates that individuals with Serious Mental Illness comprise approximately 10% of all nursing home residents (over 150,000 residents), which does not include those with less severe cases of mental illness, those residents in assisted living facilities, or those being cared for in their homes. Unfortunately, research also suggests that nursing home staff often feel ill-prepared to address the unique mental health needs of this population, and there is evidence in the literature that more staff training is needed. In phase I, investigators will develop an Internet-based SMI training intervention with state-of the-art instructional methodology. A team of national experts will be assembled to guide this process, especially in terms of differentiating how the behavior problems of residents with SMI are both alike and dissimilar to residents with dementia. Ten planned modules will be developed during Phase I and II that address common behavior problems, how to deliver care in a culturally sensitive manner to this population, and how to work with both formal and informal caregivers to achieve better mental health and health outcomes. The completed Phase I intervention will be evaluated by Certified Nursing Assistants in a limited Randomized Controlled Trial (RCT). Pre- post quantitative and qualitative analyses will be conducted as part of a Phase I experimental design study. Findings will inform Phase II research and development. Investigators anticipate a set of three commercializable modules as a result of this effort that will improve the quality of care and quality of life of residents with SMI living in the nursing home setting. PUBLIC HEALTH RELEVANCE: Narrative Ten percent of all nursing home (NH) residents have Serious Mental Illness (SMI), and this group routinely over-utilizes costly services such as hospital emergency care, public health commitment proceedings, and frequent transfers to and from NHs, where they may be frequently over-medicated and where behavioral management strategies are unfortunately not often used (Christy & Molinari, in submission). Because Certified Nurse Assistants (CNAs) report feeling both inadequately trained for and fearful of managing the care and behaviors of residents with SMI, this proposed intervention addresses these widespread public health concerns by educating CNAs about SMI and proper care strategies. Investigators' calculations in the proposal show implementation of this intervention at a single NH facility could save tens of thousands of dollars annually, potentially lowering public health costs related to SMI by over $900 million per year nationally, if adopted as a national training standard.