A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Courtney Harold Van Houtven, Cynthia J Coffman, Kasey Decosimo, Janet M Grubber, Joshua Dadolf, Caitlin Sullivan, Matthew Tucker, Rebecca Bruening, Nina R Sperber, Karen M Stechuchak, Megan Shepherd-Banigan, Nathan Boucher, Jessica E Ma, Brystana G Kaufman, Cathleen S Colón-Emeric, George L Jackson, Teresa M Damush, Leah Christensen, Virginia Wang, Kelli D Allen, Susan N Hastings
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引用次数: 0

Abstract

Objective: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well-being.

Data sources and study setting: Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans.

Study design: In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran "days not at home," and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates.

Data collection/extraction methods: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys.

Principal findings: Overall, n = 898 eligible Veterans were identified across pre-iHI-FIVES (n = 327) and post-iHI-FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days not at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31-1.09; p = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days not at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures.

Conclusions: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days not at home.

阶梯式楔形分组随机试验,评估多地点家庭照顾者技能培训计划的有效性。
目的评估退伍军人事务医疗保健系统中循证家庭照顾者培训计划(帮助投资家庭改善退伍军人经历研究[iHI-FIVES]的实施)对退伍军人不在家天数和家庭照顾者福祉的影响:参与者包括转诊到 8 个医疗中心接受家庭和社区服务并有确定照顾者的退伍军人,以及经确认符合条件的退伍军人家庭照顾者:研究设计:在一项阶梯式楔形群组随机试验中,研究机构被随机分配在 6 个月的时间间隔内启动 iHI-FIVES,并接受标准化的实施支持。使用包括协变量在内的广义线性模型比较了 iHI-FIVES 实施前和实施后时间间隔的主要结果(退伍军人 "不在家的天数")和次要结果(3 个月内照顾者幸福感指标的变化):患者数据来自电子健康记录。护理人员的数据来自两次电话调查:总体而言,在 iHI-FIVES 前(n = 327)和 iHI-FIVES 后(n = 571)期间,共确定了 n = 898 名符合条件的退伍军人。在 iHI-FIVES 后的区间内,仅有不到五分之一(17%)的退伍军人的护理人员参加了 iHI-FIVES。iHI-FIVES 前间隔期的退伍军人和护理人员的人口统计学特征与 iHI-FIVES 后间隔期的相似。在调整后的模型中,iHI-FIVES 后与 iHI-FIVES 前相比,6 个月内不在家天数的估计比率降低了 42%(比率比 = 0.58 [95% 置信区间:0.31-1.09;p = 0.09])。据估计,iHI-FIVES 实施前 6 个月内不在家的平均天数为 13.0 天,iHI-FIVES 实施后为 7.5 天。iHI-FIVES实施前和实施后3个月内,护理人员的幸福指数变化没有差异:结论:减少不在家的天数是有效的,因为在家的时间越多,生活质量就越高。在本研究中,在对退伍军人的特征进行调整后,我们没有发现实施护理人员培训计划能减少退伍军人不在家天数的证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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