Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce

Обзор

This project will compare two training models of an evidence-based online dementia care training program for direct care staff in assisted living to a waitlist control: 1) essentiALZ training and 2) essentiALZ training + Project ECHO. It will examine the extent to which each model is implemented and achieves its intended outcomes to improve staff knowledge and attitudes, change care practices, and improve the wellbeing of staff, residents, and residents' family members. Results will inform next steps in dementia care training for the assisted living (AL) and broader long-term care workforce. To examine these outcomes, data will be collected from AL staff and families over the course of 6 months. Staff will complete questionnaires and participate in interviews (as applicable) at baseline, post-training, 3-months, and 6-months. Families will participate in interviews at baseline, 3-months, and 6-months.

Подробное описание

More than 75% of persons living with Alzheimer's disease and related dementias who reach 80 years of age require residential long-term care, which is increasingly provided in assisted living (AL). Across the country, almost 29,000 AL communities with more than 996,000 beds have become the primary residential care provider for persons with dementia: 90% of AL residents have cognitive impairment and 42% have recorded moderate or severe dementia, with actual rates being higher. AL provides supportive but not nursing services; consequently, virtually all care is provided by direct care workers (nursing assistants and personal care aides).

Unfortunately, direct care workers are undervalued and under-trained, leading to poor care, workplace injury, dissatisfaction, and high turnover. AL is state-regulated, and only 17 states stipulate minimum training hours (some being as low as one hour), meaning that two-thirds of states are silent on training. Fewer than 40% of staff have education beyond high school, and so it is not surprising that a minority report sufficient knowledge to care for persons with dementia. In striving to fill this gap, training for direct care workers must be accessible and have efficacy in benefitting the staff, organization, and persons with dementia.

Online training is an especially promising option due to its low cost, wide availability, and potential for self pacing, automated skills tests, and certification. The Alzheimer's Association is the national leader in dementia care training, and in 2021 developed essentiALZ (pronounced "essentials"), an online program teaching evidence-based, person-centered care, which can be accessed from a computer, tablet, or mobile device. Already more than 1,500 staff have essentiALZ certification, but as is true of the majority of training programs, evidence as to its ability to improve care and outcomes is lacking. It is possible that essentiALZ is effective in changing care and outcomes, but it may also be that additional supports are necessary to do so. A timely model of support is Project ECHO, which has flooded the field of long-term care as a proven way to provide expert guidance and peer support via a remote, online approach. Adding ECHO to online dementia training might provide a necessary boost to achieve care change and improved outcomes.

The project responds to the National Institute on Aging Notice of Special Interest that calls for strengthening the workforce through enhancing and supporting skills training. It will conduct a hybrid implementation/effectiveness randomized trial in 126 AL communities, comparing essentiALZ alone, essentiALZ + ECHO enhancement, and a waitlist control. Outcomes grounded in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model and the Kirkpatrick training effectiveness model will be examined over six months, comparing the arms in terms of (1) implementation and (2) effectiveness, and (3) examining the extent to which implementation and effectiveness differ based on characteristics of the AL community, staff, residents, and family members. Results will inform next steps in dementia care training for the AL and broader long-term care workforce.

Вмешательства

• Поведенческое essentiALZ
  essentiALZ is a web-based training that contains three hours of self-paced content separated into five modules, plus a final review. Modules include: 1) Alzheimer's disease and dementia; 2) person-centered care; 3) assessment and care planning; 4) activities of daily living; and 5) behaviors and communication. Staff will be encouraged to take the training over the course of four weeks.
• Поведенческое Project ECHO
  ECHO is a virtual tele-mentoring model grounded in case-based learning. It includes six weekly one-hour sessions of didactic and discussive learning. The first five sessions will reflect the content of the five essentiALZ modules, and the final session will address maintenance. ECHO sessions are group sessions that will be conducted via Zoom.

Первичные конечные точки

• Change in Score Over Time of Sense of Competence in Dementia Care (SCIDS) [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of Staff Experience of Working with Residents with Dementia Questionnaire - Care Organization, Satisfactory Contact with the Patient, and Satisfaction with the Expectations of Others Subscales (SEWDRQ) [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of Dementia Attitude Scale - Short Form (DAS-6) [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]

Вторичные конечные точки (5)

• Change in Score Over Time of essentiALZ exam items [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of essentiALZ organizational practices [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of Emotional Burnout [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of Intention to Leave [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]
• Change in Score Over Time of Feeling Valued [Срок оценки: Participants will be followed for the duration of the intervention and 6 additional months after the intervention ends, an expected average of 8 months]

Критерии участия

Критерии включения

AL Staff:

• Staff (part-time, full-time, and including contract staff) who provide direct care to residents at the participating assisted living community (e.g., certified nursing assistants, personal care aides, registered nurses, licensed practical nurses, activity directors, social workers, and others) as determined by the administrator/health care supervisor
• Are 18 years of age or older
• Are able to read and speak English fluently

Family:

• Resident not expected to die or be transferred in the next six months at baseline
• At follow-up, resident lived in AL community at least one month during the three months prior to interview date
• Are a family member/legally authorized representative (LAR), or designated contact of a resident with Alzheimer's disease and related dementia (ADRD) of a participating AL community
• Are 18 years of age or older
• Are English speaking
• Visit the resident at least monthly

Критерии исключения

AL Staff \& Family:

\- Are under 18 years of age

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Да

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Организация здравоохранения

Центры проведения

США · 1 центр

• University of North Carolina at Chapel Hill — Chapel Hill

Публикации

• Alzheimer's Disease International. Dementia: A Public Health Priority. Geneva, Switzerland: World Health Organization; 2015.
• Alzheimer's Association. Alzheimer's Impact Movement March 2018. Costs of Alzheimer's to Medicare and Medicaid. http://act.alz.org/site/DocServer/2012_Costs_Fact_Sheet_version_2.pdf?docID=7161. Accessed October 30, 2021.
• Langa KM, Larson EB, Crimmins EM, Faul JD, Levine DA, Kabeto MU, Weir DR. A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JAMA Intern Med. 2017 Jan 1;177(1):51-58. doi: 10.1001/jamainternmed.2016.6807. PMID 27893041
• Friedman EM, Shih RA, Langa KM, Hurd MD. US Prevalence And Predictors Of Informal Caregiving For Dementia. Health Aff (Millwood). 2015 Oct;34(10):1637-41. doi: 10.1377/hlthaff.2015.0510. PMID 26438738
• Arrighi HM, Neumann PJ, Lieberburg IM, Townsend RJ. Lethality of Alzheimer disease and its impact on nursing home placement. Alzheimer Dis Assoc Disord. 2010 Jan-Mar;24(1):90-5. doi: 10.1097/WAD.0b013e31819fe7d1. PMID 19568155
• Zimmerman S, Gruber-Baldini AL, Sloane PD, Eckert JK, Hebel JR, Morgan LA, Stearns SC, Wildfire J, Magaziner J, Chen C, Konrad TR. Assisted living and nursing homes: apples and oranges? Gerontologist. 2003 Apr;43 Spec No 2:107-17. doi: 10.1093/geront/43.suppl_2.107. PMID 12711731
• Zimmerman S, Love K, Cohen LW, Pinkowitz J, Nyrop KA. Person-Centeredness in Home- and Community-Based Services and Supports: Domains, Attributes, and Assisted Living Indicators. Clin Gerontol. 2014;37(5):429-445. doi: 10.1080/07317115.2014.937548. Epub 2014 Jun 30. PMID 29033493
• Smith M, Buckwalter KC, Kang H, Ellingrod V, Schultz SK. Dementia care in assisted living: needs and challenges. Issues Ment Health Nurs. 2008 Aug;29(8):817-38. doi: 10.1080/01612840802182839. PMID 18649209

Идентификаторы

NCT: NCT06239688 · 23-1643 · R01AG079124

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗