Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial.
Background and Objectives Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses imp...
| Publicado en: | Gerontologist Vol. 62; no. 2; pp. 304 - 315 |
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| Autores principales: | , , , , , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Mar2022
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=155212779&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 155212779 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00169013 GET jtl: Gerontologist issn: 00169013 maglogo: N pubinfo: dt: Mar2022 vid: 62 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 155212779 10.1093/geront/gnaa220 ppf: 304 ppct: 11 formats: tig: atl: Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial. aug: au: Lin, Shih-Yin Schneider, Catherine E Bristol, Alycia A Clancy, Maureen Sprague, Sara A Aldridge, Melissa Cortes, Tara Goldfeld, Keith S Kutner, Jean S Mitchell, Susan L Shega, Joseph W Wu, Bei Zhu, Carolyn W Brody, Abraham A affil: Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing , New York, New York, USA College of Nursing, University of Utah , Salt Lake City, Utah, USA MJHS Hospice and Palliative Care , New York, New York, USA Providence TrinityCare Hospice , Torrance, California, USA Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York, USA James J. Peters VA Medical Center , Bronx, New York, USA Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine , New York, New York, USA Department of Medicine, University of Colorado School of Medicine , Aurora, Colorado, USA Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife , Boston, Massachusetts, USA Department of Medicine, Beth Israel Deaconess Medical Center , Boston, Massachusetts, USA Vitas Healthcare , Miami, Florida, USA College of Medicine, University of Central Florida , Orlando, Florida, USA su: Hospice care Clinical trials Human services programs Labor turnover Dementia prevention Pilot projects Dementia patients Surveys Quality assurance Health care teams Descriptive statistics Electronic health records sug: subj: Hospice care Clinical trials Human services programs Labor turnover Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology) Home Health Care Services Nursing Care Facilities (Skilled Nursing Facilities) Dementia prevention Pilot projects Dementia patients Surveys Quality assurance Health care teams Descriptive statistics Electronic health records keyword: ADRD Hospice Implementation science Interdisciplinary workforce training Quality assurance and performance improvement ADRD Hospice Implementation science Interdisciplinary workforce training Quality assurance and performance improvement ab: Background and Objectives Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. Research Design and Methods Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care—Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate ("feasibility"), ≥80% posttraining survey respondents indicating intention for practice changes ("applicability"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining ("fidelity"). Results Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. Discussion and Implications This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. Clinical Trials Registration Number NCT03681119 pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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