The Hospice Advanced Dementia Symptom Management and Quality of Life Trial (HAS-QOL) Stepped Wedge Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 44,143
- 试验地点
- 1
- 主要终点
- Change from Baseline in Monthly Percentage of Home Hospice Patients who are Prescribed Antipsychotic Medication
研究概览
简要总结
The Aliviado Dementia Care Program (formerly known as the Dementia Symptom Management at Home Program, or DSM-H) was developed to implement dementia friendly care for persons with Dementia and their caregivers living in the community. Aliviado Dementia Care-Hospice Edition is a systems level quality assurance performance improvement program that includes interdisciplinary team training, validated assessment instruments, patient-centered care plans, treatment algorithms for behavioral and psychological symptoms of dementia and terminal delirium, and caregiver education pamphlets. Utilizing the R61/R33 mechanism, the Aliviado Dementia Care-Hospice Edition was successfully implemented in 2 sequential pilot trials in the hospice setting in 2019 (R61 phase). Following the successful pilot trials and the attainment of the R61 milestones, the investigators now seek to test the effectiveness of Aliviado Dementia Care-Hospice Edition in a pragmatic RCT in 25 hospice agencies across the nation (R33 phase) on its ability to reduce antipsychotic use (primary outcome) and effect quality (secondary and exploratory outcomes).
详细描述
As the population ages, the incidence rate of Alzheimer's Disease and Related Disorders (dementia) is expected to triple. The National Alzheimer's Plan recognizes that while the number of persons with dementia (PWD) is increasing substantially, the healthcare and long term care systems are unprepared to provide high quality, effective and efficient care to the PWD and their caregivers. PWD often have many behavioral and psychological symptoms of dementia (BPSD) including agitation, depression and sleep disturbances that affect both the quality of life (QOL) of the PWD and the caregiver. Unfortunately, due to a lack of programs to insert evidence-based care into the community, and hospice system specifically, PWD receive inappropriate and even harmful care. The investigators have developed the Aliviado Dementia Care Program (formerly known as the Dementia Symptom Management at Home Program, or DSM-H) to implement dementia friendly care for PWD and their caregivers in the community. Initially developed for use in home healthcare (HHC), the investigators have modified the program for use in hospice. The Aliviado Dementia Care-Hospice Edition is a systems level quality assurance performance improvement (QAPI) program that includes workforce training, and agency level workflow changes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Sequential
- 主要目的
- Supportive Care
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Interdisciplinary Team (IDT) MEMBERS:
- •All English speaking IDT members
- •Employed or contracted by the participating agency who are receiving Aliviado Dementia Care-Hospice Edition online or champion training
- •All PWD (Persons with dementia) who are newly admitted to a participating hospice during the timeframe following implementation of the intervention who are over the age of 50 and have an ICD-10 code corresponding to a dementia diagnosis in their chart will be eligible.
- •Greater than 18 years of age
排除标准
- •IDT MEMBERS:
- •IDT members who are per diem
结局指标
主要结局
Change from Baseline in Monthly Percentage of Home Hospice Patients who are Prescribed Antipsychotic Medication
时间窗: Baseline, Month 26
Antipsychotic use measured using medical records.
Change from Baseline in Monthly Percentage of Home Hospice Patients who are Prescribed Non-Opioid Analgesic Medication
时间窗: Baseline, Month 26
Non-opioid analgesic use measured using medical records.
次要结局
- Change from Baseline in Monthly Hours of Continuous Hospice Use(Baseline, Month 26)
- Change from Baseline in Monthly Days of Inpatient Hospice Use(Baseline, Month 26)
- Change from Baseline in Monthly Days of Respite Care(Baseline, Month 26)
- Change from Baseline in Monthly Percentage of Participants who are Permanently Institutionalized in a Nursing Home(Baseline, Month 26)