Engaging Hospitalized Patients and Family Caregivers to Identify and Prevent Delirium Superimposed on Dementia: An Intervention Mapping Approach.

项目摘要/摘要 这项职业发展提案将为加州大学内科科学家、医学博士、医学硕士布莱尔·戈尔德提供 威斯康星-麦迪逊医学院和公共卫生学院，以及成功成为一名 独立调查员研究干预措施以改善以患者和家庭为中心的护理的提供 适用于阿尔茨海默病和阿尔茨海默病相关痴呆症(AD/ADRD)住院成年人。 所有住院的AD/ADRD患者中，近一半患有痴呆症(DSD)， 这与严重的发病率和死亡率有关。渠务署亦会对家庭造成不良影响 照顾者，加剧了先前存在的照顾者的压力和对福祉的负面影响。尽管它的 由于负担沉重，DSD在住院患者中仍未被发现和管理不善，部分原因是 评估先前存在的损害和其他个人特征的方法不发达 对于提供量身定制的预防战略至关重要。针对精神错乱的循证计划强调 家庭参与在认可和管理中的作用，但积极参与家庭的方法 成员和AD/ADRD患者在DSD的检测和预防方面仍不发达。这个 这项K23提案的首要目标是建立以患者和家庭照顾者为中心的沟通和 能够主动满足信息需求并争取参与DSD的参与实践 识别和预防是可行的和可扩展的。了解家人与患者的沟通 而关于DSD的信息需求不仅可以改善患者和以家庭为中心的护理的交付， 而且还有可能减少家庭和患者的痛苦，并改进DSD的识别和预防。作为一名 他是一家机构的初级教员，拥有广泛的基础设施来支持早期调查人员。 戈尔登正处于完成拟议研究项目和进行高级培训的最佳环境中。 她的职业发展计划包括正式课程、强化指导和1)体验式培训 混合方法、调查和干预地图方法2)精神错乱的评估和预防3) AD/ADRD患者的研究投入和临床护理；4)务实的临床试验设计。至 为了确保成功，她已经在这些学科中找到了专家导师，他们在培训中有着出色的记录 独立调查人员和这项工作的安全保障时间。该奖项针对的是一项重要的临床研究 AD/ADRD和精神障碍的研究在提供教育和指导的同时陷入困境和严重差距 研究经验对于戈登博士领导独立研究项目至关重要。

PROJECT SUMMARY/ABSTRACT This career development proposal will provide Blair Golden, MD MS, a physician-scientist at The University of Wisconsin-Madison School of Medicine and Public Health, with the training required for success as an independent investigator researching interventions to improve the delivery of patient- and family-centered care for hospitalized adults with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD). Nearly half of all hospitalized patients with AD/ADRD develop delirium superimposed on dementia (DSD), which is associated with significant morbidity and mortality. DSD also leads to adverse impacts for family caregivers, compounding pre-existing caregiver stresses and negative impacts on wellbeing. Despite its substantial burden, DSD remains under-detected and poorly managed in hospitalized patients due in part to under-developed approaches for assessing pre-existing impairment and other individual characteristics that are critical to delivering tailored prevention strategies. Evidence-based programs for delirium have emphasized the role of family engagement in recognition and management, but approaches to proactively engaging family members and patients with AD/ADRD in DSD detection and prevention remain underdeveloped. The overarching goal of this K23 proposal is to establish patient and family caregiver-centered communication and engagement practices capable of proactively addressing information needs and soliciting participation in DSD identification and prevention that are feasible and scalable. Understanding family and patient communication and information needs regarding DSD could not only improve the delivery of patient and family-centered care, but also potentially reduce family and patient suffering and improve DSD identification and prevention. As a junior faculty member at an institution with extensive infrastructure to support early-stage investigators, Dr. Golden is in an optimal environment to complete the proposed research project and pursue advanced training. Her career development plan includes formal coursework, intensive mentorship, and experiential training in 1) mixed methods, survey, and intervention mapping approaches 2) delirium assessment and prevention 3) research engagement and clinical care of patients with AD/ADRD and 4) pragmatic clinical trial design. To ensure success, she has identified expert mentors in these disciplines with outstanding track records in training independent investigators and secured protected time for this work. This award addresses a significant clinical dilemma and serious gap in AD/ADRD and delirium research while affording the education and mentored research experience critical to prepare Dr. Golden to lead an independent research program.