Hospital GamePlan4Care: A Web-Based Delivery System for Dementia Caregiver Support

这是阿尔茨海默病和相关痴呆症(ADRD)的指导医师-科学家奖 莫莉·霍斯特曼博士的申请，她是一名住院医生和弗吉尼亚州迈克尔·E·德贝基大学的卫生服务研究员 医学中心，她在医院医学的十字路口确立了自己作为一名年轻研究员的地位， 痴呆症和照顾他人。这项奖励将为霍斯特曼博士提供必要的支持，以开发 ADRD和痴呆症护理方面的专门知识，(2)接受执行科学研究方面的正式培训 方法，和(3)获得必要的经验，以确立自己作为一个独立的内科科学家。至 为了实现这些目标，霍斯特曼博士组建了一个多学科指导团队，由全国公认的 ADRD、痴呆症护理、老年病学和实施科学研究方法的研究人员。 住院是患有ADRD的退伍军人和他们的家庭照顾者的哨兵事件。成年人患有 ADRD患者通常会因新的功能和认知障碍而出院，这会增加 出院后对家庭照顾者的要求。这些不断变化的照顾者需求增加了照顾者 压力，这可能会导致照顾者和接受者更糟糕的结果。经过20多年的研究， 证明了在医院开始的护理过渡干预可以改善患者的预后。 此外，护理过渡干预措施从医院开始，专门为满足需求而设计 已被证明可以减轻照顾者的负担和焦虑，并减少急性护理资源 使用以下排泄器。到目前为止，这一证据基础支持量身定制的干预措施，以满足特定的 照顾者的需求还没有转化为在护理过渡期间对痴呆症照顾者的支持。 增强阿尔茨海默氏症照顾者健康的资源(REACH II)是一个多成分的、以证据为基础的 ADRD照顾者支持计划已在退伍军人健康中心进行调整和实施 达到退伍军人事务部的行政管理。在社区交付时，REACH II和REACH VA被关联 随着照顾者抑郁、照顾者社会支持和照顾者自我护理的改善， 照顾者负担与照顾者的问题行为。循证干预，如REACH II， 由于需要护理人员和 痴呆症护理专家进行技能培训。GamePlan4Care(GP4C)是一个基于网络的新型培训平台 旨在在可接受且可扩展的在线平台中完全复制REACH II的核心组件 由以用户为中心的测试提供信息。适应医院环境以包括护理过渡培训， GP4C具有巨大的潜力，可以在护理过渡期间改变对ADRD照顾者的支持。 这项提案将把循证护理过渡培训与现有的痴呆症护理人员结合起来 支持介入，打造全新独特的介入：医院GP4C。使用计划的改编 方法，我们将在现有的GP4C平台上构建，以结合强大的证据支持量身定制 护理、过渡、培训和支持。目标是：1)使GP4C适应医院护理(医院GP4C)，2) 评估医院GP4C干预的可行性和可接受性，以及3)评估照顾者- 医院GP4C与健康对照的先导性随机研究的报告结果和保留率 教育。在目标1中，将使用与照顾者和工作人员的半结构化访谈来告知计划的 适用于医院护理的GP4C。将使用以人为中心的设计来开发特定的护理过渡 补充现有GP4C内容的内容。在目标2中，将收集定量和定性数据以 评估医院GP4C的可行性和可接受性。在目标3中，一项单一地点试点随机研究 医院将GP4C与健康教育对照进行对照。护理员将在 医院。这一奖项的结果将成为VA优秀奖的多点随机对照试验 医院GP4C。

This is a Mentored Physician-Scientist Award in Alzheimer’s Disease and Related Dementias (ADRD) application for Dr. Molly Horstman, a hospitalist and health services researcher at the Michael E. DeBakey VA Medical Center, who is establishing herself as a young investigator at the intersection of hospital medicine, dementia, and caregiving. This award will provide Dr. Horstman with the necessary support (1) to develop expertise in ADRD and dementia caregiving, (2) to receive formal training in implementation science research methods, and (3) to gain the experience needed to establish herself as an independent physician-scientist. To achieve these goals, Dr. Horstman has assembled a multidisciplinary mentoring team of nationally recognized investigators in ADRD, Dementia Caregiving, Geriatrics, and Implementation Science research methods. Hospital admissions are sentinel events for Veterans with ADRD and their family caregivers. Adults with ADRD are often discharged from the hospital with new functional and cognitive limitations, which increases demands on family caregivers following discharge. These changing caregiver demands increase caregiver stress, which can lead to worse outcomes for caregivers and care recipients. Over 20 years of research has demonstrated that care transitions interventions started in the hospital can improve outcomes for patients. Furthermore, care transitions interventions started in the hospital and designed specifically to meet the needs of stroke caregivers have been shown to reduce caregiver burden and anxiety and reduce acute care resource use following discharge. To date, this evidence base supporting tailored interventions to meet specific caregiver needs has not been translated to the support for dementia caregivers during care transitions. Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) is a multicomponent, evidence-based ADRD caregiver support program that has been adapted and implemented in the Veterans Health Administration as REACH VA. When delivered in the community, REACH II and REACH VA were associated with improvements in caregiver depression, caregiver social support, and caregiver self-care and a decrease in caregiver burden and problem behaviors in the care recipient. Evidence-based interventions, like REACH II, are challenging to scale and spread due to the need for one-on-one interactions between caregivers and dementia care specialists for skills training. GamePlan4Care (GP4C) is a novel, web-based training platform designed to fully replicate the core components of REACH II in an acceptable and scalable online platform informed by user-centered testing. With adaptation to the hospital setting to include care transitions training, GP4C has great potential to transform the support of ADRD caregivers during care transitions. This proposal will combine evidence-informed care transitions training with an existing dementia caregiver support intervention to create a new and unique intervention: Hospital GP4C. Using a Planned Adaptation Approach, we will build on the existing GP4C platform to incorporate the robust evidence supporting tailored care transitions training and support. The aims are to: 1) adapt GP4C for hospital care (Hospital GP4C), 2) evaluate the feasibility and acceptability of the Hospital GP4C intervention, and 3) to evaluate caregiver- reported outcomes and retention rates in a pilot randomized study of Hospital GP4C compared to health education. In Aim 1, semi-structured interviews with caregivers and staff will be used to inform the planned adaptation of GP4C for hospital care. Human-centered design will be used to develop care transitions specific content to supplement existing GP4C content. In Aim 2, quantitative and qualitative data will be collected to assess the feasibility and acceptability of Hospital GP4C. In Aim 3, a single site pilot randomized study of Hospital GP4C compared to a health education control will be conducted. Caregivers will be recruited in the hospital. The results of this award will inform a VA Merit Award for a multisite randomized controlled trial of Hospital GP4C.