From Evidence-Base to Practice: Implementing RDAD in AAA Community-Based Services

描述(由申请人提供)：本提案响应PA-11-123：帮助老年人在社区中保持健康和独立的翻译研究。这是对RDAD(减少阿尔茨海默病中的残疾)的翻译调查，RDAD是一个循证计划(发表在JAMA上，并由美国老龄循证干预拨款计划推荐传播)。RDAD已经证明了在帮助患有痴呆症的老年人保持身体功能和改变长期护理安置方面的有效性。这是一个实用和可扩展的计划，具有将循证科学发现付诸实践的明显潜力。地区老龄机构(AAA)与跨学科和多学科研究人员将建立良好的合作伙伴关系，以调查由AAA工作人员在其社区内管理的RDAD的翻译、实施和有效性。这项调查有可能对公众产生重大影响 健康，改善老年痴呆症患者及其照顾者的健康和独立性。该项目的成功完成将推动翻译科学领域向前发展，方法是让社区合作伙伴参与研究的每个阶段，使用两种广受好评的翻译工作战略(NIH行为改变联盟(BCC)和REACH、功效/有效性、采用、实施和维护(RE-AIM))，并采用既定的程序和结果衡量标准来评估效果。定性和定量数据将解决两个主要研究问题：1)AAA合作伙伴能否成功地翻译和实施RDAD，2)AAA实施RDAD在机构、提供者和患有痴呆症的老年人及其家庭成员中是否有效地产生预期的结果。65岁及以上患有痴呆症的成年人及其家庭照顾者(240对)将在俄勒冈州和华盛顿州的城市和农村AAA参加RDAD。将采用重复测量的交错时间序列设计，执行时间的AAA随机化。主要结果包括受照者的身体活动、功能状态和居住状况；次要结果包括受照者和照顾者的健康、情绪和生活质量、受照者行为和照顾者感受到的压力。具体目标是评估：1)AAA翻译和实施RDAD的情况；2)RDAD对老年痴呆症患者及其家庭照顾者的身体健康和独立性结果的有效性；以及3)社区合作伙伴感兴趣的RDAD结果，包括各级参与者(参与者、提供者和机构)对计划的满意度、计划交付成本和相关的医疗成本。假设：1)AAA将成功实施RDAD；2)参与者(护理接受者和照顾者)在干预后与基线相比将有明显更好的结果；3)参与者、提供者和AAA将报告对RDAD的满意度；计划交付成本将与其他AAA照顾者计划相当；实施后参与者医疗成本流将减少。1

DESCRIPTION (provided by applicant): This proposal responds to PA-11-123: Translational Research to Help Older Adults Maintain their Health and Independence in the Community. It is a translational investigation of RDAD (Reducing Disabilities in Alzheimer's Disease), an evidence-based program (published in JAMA and recommended for dissemination by the U.S. Administration on Aging Evidence-Based Intervention Grants Program). RDAD has demonstrated efficacy in helping older adults with dementia maintain physical function and alter long term care placement. It is a practical and scalable program with clear potential for moving evidence-based science findings into practice. A well-established partnership of Area Agencies on Aging (AAAs) and interdisciplinary and multidisciplinary researchers will collaborate to investigate the translation, implementation, and effectiveness of RDAD administered by AAA staff within their communities. This investigation has the potential to significantly affect public health, improving health and independence of older adults with dementia and their caregivers. The successful completion of this project will move the field of translational science forward by involving community partners in each phase of study, using two well-regarded strategies for translational work (NIH Behavioral Change Consortium (BCC) and Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM)), and applying established process and outcome measures to evaluate effectiveness. Qualitative and quantitative data will address two primary research questions: 1) Can AAA partners successfully translate and implement RDAD, and 2) Is AAA implementation of RDAD effective in producing desired outcomes among agencies, providers, and older adults with dementia and their family members. Adults age 65 and older with dementia and their family caregivers (240 dyads) will be enrolled in RDAD in both urban and rural AAAs in Oregon and Washington. A staggered time series design with repeated measures will be employed, with AAAs randomized for the time of implementation. Primary outcomes include care-recipient physical activity, functional status, and residential status; secondary outcomes include care-recipient and caregiver health, mood, and quality of life, care-recipient behavior, and caregiver perceived stress. Specific aims are to evaluate: 1) the translation and implementation of RDAD by AAAs; 2) RDAD effectiveness on outcomes of physical health and independence among older adults with dementia and their family caregivers; and 3) RDAD outcomes of interest to community partners, including satisfaction with the program among those involved at each level (participant, provider, and agency), program delivery costs, and associated health care costs. Hypotheses are:1) AAAs will successfully implement RDAD; 2) Participants (care-recipients and caregivers) will have significantly better outcomes following intervention as compared to baseline; and 3) Participants, providers, and AAAs will report satisfaction with RDAD; program delivery costs will be comparable to other AAA caregiver programs; and participant health care cost-streams will be reduced following implementation. 1