Implementation of EIT-4-BPSD in Nursing Homes

摘要 痴呆症的行为和心理症状(BPSD)包括攻击性、激越、抑郁、 焦虑、冷漠和幻觉，高达90%的养老院居民患有痴呆症。 对于居民来说，BPSD会导致负面的健康结果，身体功能下降，并可能 增加不适当使用抗精神病药物(AP)和身体约束。BPSD还有助于 长期护理的高成本。我们和其他研究人员已经证明，行为方法可以减少 BPSD。医疗保险和医疗补助服务中心(CMS)在其国家伙伴关系中改善 痴呆症护理和减少疗养院抗精神病药物的使用现在集中在 养老院调查确保以人为本为痴呆症患者提供护理 行为方法。以人为中心的关怀侧重于个人之间的合作伙伴关系， 他们的家庭和提供者，并强调健康和福祉，通过响应个人的 优先事项、目标和需求。不幸的是，只有不到2%的养老院实施了这些变化。 使用行为方法的主要障碍是员工的知识、技能和动机有限 利用这些方法。拟议的研究回应了实施以人为本的需要 基于循证实践的BPSD管理方法探讨 实施策略称为证据整合三角(EIT)。我们与CMS合作 推进国家伙伴关系，并制定了一份全面的同行审议/专家简编- 批准的资源用于利用以人为中心的行为方法来应对BPSD(即疗养院 工具包；NursinghomToolkit.com)。推进以人为本的行为管理 对于BPSD，我们合并了工具包和我们之前测试过的4步方法，作为克服障碍的一种方式 到实施。这些步骤包括：步骤1.环境和政策评估；步骤2.教育 工作人员；步骤3.建立以人为本的护理计划；步骤4.指导和激励工作人员) 制定EIT-4-BPSD的EIT实施战略。我们提出了一项整群随机试验，有50 养老院随机分为EIT-4-BPSD或仅限教育(EO)。我们的目标是：1：实施和测试 EIT-4-BPSD；和2：评估EIT战略的使用情况以及我们与工作人员共同参与的实施进程。 这项研究的发现将增加关于护理中实施有效干预的已知情况 将作为其他方案和护理方法的典范，并将帮助设施和工作人员 实施优质的以人为本的关怀，这是国家伙伴关系的最终目标。

Abstract Behavioral and Psychological Symptoms of Dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home residents with dementia. For residents, BPSD contribute to negative health outcomes, a decline in physical functioning, and may increase the inappropriate use of antipsychotic drugs (AP) and physical restraints. BPSD also contribute to the high cost of long term care. We, and other researchers, have shown that behavioral approaches can reduce BPSD. The Centers for Medicare and Medicaid Services (CMS) in their National Partnership to Improve Dementia Care and Reduce Antipsychotic Use in Nursing Homes has now focused regulatory efforts during the nursing home survey on ensuring that care for residents with dementia is delivered using person-centered behavioral approaches. Person-centered care is focused on collaborative partnerships among individuals, their families and providers and emphasizes health and well-being by being responsive to an individual's priorities, goals and needs. Unfortunately, less than 2% of nursing homes have implemented these changes. The major barriers to use of behavioral approaches are limited knowledge, skills and motivation of staff to utilize these approaches. The proposed research responds to the need to implement a person-centered approach to management of BPSD by testing evidence-based practice for BPSD under conditions of an implementation strategy referred to as the Evidence Integration Triangle (EIT). We worked with CMS to advance the National Partnership and developed a comprehensive compendium of peer-reviewed/expert- endorsed resources for utilizing person-centered, behavioral approaches to BPSD (i.e., a Nursing Home Toolkit; nursinghometoolkit.com). To facilitate implementation of the person-centered behavioral management of BPSD we merged the Toolkit and our previously tested 4-step approach as a way to overcome the barriers to implementation. The steps include: Step 1. Assessment of the Environment and Policies; Step 2. Education of Staff; Step 3. Establishing Person Centered Care Plans; and Step 4. Mentoring and Motivating of Staff) with the EIT implementation strategy to develop the EIT-4- BPSD. We propose a cluster randomized trial with 50 nursing homes randomized to EIT-4-BPSD or Education Only (EO). Our aims are to: 1: implement and test EIT-4-BPSD; and 2: evaluate use of the EIT strategy and our participatory implementation process with staff. The findings from this study will add to what is known about implementation of effective interventions in nursing homes, will serve as a model for other programs and care approaches, and will help facilities and staff implement quality person-centered care, the ultimate goal of the National Partnership.