Medication Management During Hospital-to-Home Transitions of Older Adults with Alzheimer's Disease and Related Dementias (ADRD)

护理过渡是指一个人从一个医疗保健环境转移到另一个医疗保健环境。从医院到家 过渡期是一个高风险时期，尤其是对于用药错误和不良事件以及患有 阿尔茨海默病和相关痴呆(ADRD)。指导护理过渡的研究相对较少 改善ADRD人口的努力。对于患有ADRD的老年人来说， 从医院到家庭的转变是关于药物管理(MM)的角色模糊。MM中的角色模糊 当患有ADRD的老年人、非正式照顾者和医疗保健提供者的角色仍然没有 明确界定谁负责完成MM相关任务，如药物对账。 当前提案的目标是(1)确定与药物相关的角色模糊相关的问题 在医院到家庭的过渡期间威胁患有ADRD的老年人的安全的管理，以及(2) 让利益相关者制定一套专门针对ADRD的战略，以减少角色模糊和支持 嗯，在这个高风险的过渡中。 具体目标1：确定与药物管理有关的关键任务，并对形成因素进行分类 对老年ADRD患者从医院到家庭过渡过程中任务分配的期望。我们会 制定关键MM任务的流程图，并对影响老年人和非正式人员的因素进行分类 照顾者对MM任务分配的期望通过(1)在初始家庭中的直接观察和访谈 最近住院的老年ADRD患者及其非正式照顾者的健康探访；(2)照片 用于在家里支持MM的对象；以及(3)征求参与者日记，然后是日记后半 与非正式照顾者进行有组织的访谈。 具体目标2：确定利益攸关方战略并确定其优先顺序，以管理预期和分配任务 减少角色模糊，支持医院到家的成功用药管理 过渡。在人类因素工程学领域的参与式人体工程学方法的指导下，我们将 组成干预改进小组(IRT)，由患有ADRD的老年人、非正式照顾者和 参与医院到家庭过渡的医疗保健提供者。IRT将开会使用医院的调查结果- 到家的流程图(目标1)，制定策略，并根据(1)重要性对每个策略进行评级 减少角色模糊，(2)支持MM的有效性的可能性，以及(3)可操作性的水平。 我们研究的长期目标是开发、评估和传播最佳实践，以提供最佳 为患有ADRD的老年人提供医疗保健，因为他们在不同的医疗保健环境中过渡。 完成这些目标将产生一套利益相关者知情的战略，以支持MM的研究结果 将为未来的工作奠定基础，以开发和测试行为或技术解决方案 患有ADRD的老年人在从医院到家庭过渡期间的未得到满足的需求和安全风险。

Care transitions are the movement of a person from one healthcare setting to another. The hospital-to-home transition is a high-risk period, especially for medication errors and adverse events and for persons with Alzheimer's disease and related dementias (ADRD). There is relatively little research to guide care transition improvement efforts for the ADRD population. An area of particular risk for older adults with ADRD during the hospital-to-home transition is role ambiguity regarding medication management (MM). Role ambiguity in MM occurs when the roles of older adults with ADRD, informal caregivers, and healthcare providers remain without a clear definition of who is responsible for completion of MM-related tasks, such as medication reconciliation. The goal of the current proposal is to (1) identify issues related to role ambiguity regarding medication management that threaten the safety of older adults with ADRD during hospital-to-home transitions, and (2) engage stakeholders to develop a set of strategies specific to ADRD to decrease role ambiguity and support MM during this high-risk transition. Specific Aim 1: Identify critical tasks regarding medication management and categorize factors shaping expectations for task distribution during hospital-to-home transitions of older adults with ADRD. We will develop process-flow diagrams of critical MM tasks and categorize factors shaping older adult and informal caregiver expectations for MM task distribution through (1) direct observations and interviews during initial home health visits of recently hospitalized older adults with ADRD and their informal caregivers; (2) photographs of objects used to support MM in the home; and (3) solicited participant diaries followed by post-diary semi- structured interviews with informal caregivers. Specific Aim 2: Identify and prioritize stakeholder strategies to manage expectations and distribute tasks to decrease role ambiguity and support successful medication management during hospital-to-home transitions. Guided by a participatory ergonomics approach from the field of human factors engineering, we will form an intervention refinement team (IRT) comprised of older adults with ADRD, informal caregivers, and healthcare providers involved in hospital-to-home transitions. The IRT will meet to use findings from the hospital- to-home process-flow diagram (Aim 1) to develop strategies and rate each strategy according to (1) importance to reducing role ambiguity, (2) likelihood of effectiveness in supporting MM, and (3) level of actionability. The long-term goal of our research is to develop, evaluate, and disseminate best practices to deliver optimal health care to older adults with ADRD in all stages of disease as they transition across healthcare settings. Completion of these aims will result in a stakeholder-informed set of strategies to support MM. Study findings will build a foundation for future work to develop and test a behavioral or technological solution to address unmet needs and safety risks during the hospital-to-home transition for older adults with ADRD.