A Training and Fidelity Model to Move and Scale Evidence-based Dementia Care and Caregiver Support Programs into Practice: The Case for COPE in PACE service settings

这项NIA第一阶段研究旨在解决实施的两个主要障碍 将循证痴呆症护理和护理者支持计划纳入长期护理环境：(1) 缺乏精简、用户友好且经过测试的培训模式，以及(2)缺乏可扩展、 在“真实世界”环境中准确测量保真度的实用流程。这项研究的目的 是确定在线培训计划在改进方面是相同还是更好 干预者对循证痴呆计划(COPE)和痴呆症患者的忠诚度 与高强度的面对面的传统训练形式相比，结果更好。至 为了实现这些目标，我们将开发一种在线的、原则驱动的方法，使用最新的- 科学模拟和最佳实践以及评估保真度的可扩展方法 应用计算语言学技术。然后我们将进行一次非劣质审判， 为所有随机分配给老年人的包容性关怀(PACE)组织提供的计划 训练条件。佩斯的工作人员将在培训后接受评估，了解他们的忠诚度结果。二元体 痴呆症患者及其照顾者的比例将在治疗后4个月进行评估 对功能、神经精神症状、生活质量和照顾者负担的执行情况。 这个项目的发现将为大规模的第三至第四阶段奠定必要的基础， 在全美的PACE环境中对COPE进行务实的试验。调查结果也将作为一项 指导开发实用的、可扩展的培训和忠诚度流程的模式 在其他长期护理环境和其他循证支持计划中进行监测。

This NIA Stage I study is designed to address two leading barriers to implementation of evidence-based dementia care and caregiver support programs into long-term care settings: (1) lack of streamlined, user-friendly, and tested training modalities, and (2) lack of scalable, practical processes to accurately measure fidelity in “real world” settings. The aims of the study are to determine whether an online training program is the same or better in improving interventionist fidelity to an evidence based dementia program (COPE) and dementia patient outcomes when compared to a high intensity face-to-face traditional form of training. To accomplish these aims we will develop an online, principle-driven approach using state-of-the- science simulation and best practices and a scalable approach to assess fidelity to COPE by applying computational linguistics techniques. We will then conduct a noninferiority trial in Programs for All Inclusive Care for Elders (PACE) organizations randomly assigned to the training conditions. PACE staff will be evaluated post training on their fidelity outcomes. Dyads of persons with dementia and their caregivers will be evaluated at 4 months post COPE implementation on function, neuropsychiatric symptoms, quality of life, and caregiver burden. The findings from this project will lay the essential groundwork for a large scale, Stage III-IV, pragmatic trial of COPE in PACE settings throughout the US. Findings will also serve as a model for guiding the development of practical, scalable processes for training and fidelity monitoring in other long-term care settings and for other evidence-based support programs.