Abstract

This is a Mentored Physician-Scientist Award in Alzheimer’s Disease and Related Dementias (ADRD) application for Dr. Molly Horstman, a hospitalist and health services researcher at the Michael E. DeBakey VA Medical Center, who is establishing herself as a young investigator at the intersection of hospital medicine, dementia, and caregiving. This award will provide Dr. Horstman with the necessary support (1) to develop expertise in ADRD and dementia caregiving, (2) to receive formal training in implementation science research methods, and (3) to gain the experience needed to establish herself as an independent physician-scientist. To achieve these goals, Dr. Horstman has assembled a multidisciplinary mentoring team of nationally recognized investigators in ADRD, Dementia Caregiving, Geriatrics, and Implementation Science research methods. Hospital admissions are sentinel events for Veterans with ADRD and their family caregivers. Adults with ADRD are often discharged from the hospital with new functional and cognitive limitations, which increases demands on family caregivers following discharge. These changing caregiver demands increase caregiver stress, which can lead to worse outcomes for caregivers and care recipients. Over 20 years of research has demonstrated that care transitions interventions started in the hospital can improve outcomes for patients. Furthermore, care transitions interventions started in the hospital and designed specifically to meet the needs of stroke caregivers have been shown to reduce caregiver burden and anxiety and reduce acute care resource use following discharge. To date, this evidence base supporting tailored interventions to meet specific caregiver needs has not been translated to the support for dementia caregivers during care transitions. Resources for Enhancing Alzheimer’s Caregiver Health (REACH II) is a multicomponent, evidence-based ADRD caregiver support program that has been adapted and implemented in the Veterans Health Administration as REACH VA. When delivered in the community, REACH II and REACH VA were associated with improvements in caregiver depression, caregiver social support, and caregiver self-care and a decrease in caregiver burden and problem behaviors in the care recipient. Evidence-based interventions, like REACH II, are challenging to scale and spread due to the need for one-on-one interactions between caregivers and dementia care specialists for skills training. GamePlan4Care (GP4C) is a novel, web-based training platform designed to fully replicate the core components of REACH II in an acceptable and scalable online platform informed by user-centered testing. With adaptation to the hospital setting to include care transitions training, GP4C has great potential to transform the support of ADRD caregivers during care transitions. This proposal will combine evidence-informed care transitions training with an existing dementia caregiver support intervention to create a new and unique intervention: Hospital GP4C. Using a Planned Adaptation Approach, we will build on the existing GP4C platform to incorporate the robust evidence supporting tailored care transitions training and support. The aims are to: 1) adapt GP4C for hospital care (Hospital GP4C), 2) evaluate the feasibility and acceptability of the Hospital GP4C intervention, and 3) to evaluate caregiver- reported outcomes and retention rates in a pilot randomized study of Hospital GP4C compared to health education. In Aim 1, semi-structured interviews with caregivers and staff will be used to inform the planned adaptation of GP4C for hospital care. Human-centered design will be used to develop care transitions specific content to supplement existing GP4C content. In Aim 2, quantitative and qualitative data will be collected to assess the feasibility and acceptability of Hospital GP4C. In Aim 3, a single site pilot randomized study of Hospital GP4C compared to a health education control will be conducted. Caregivers will be recruited in the hospital. The results of this award will inform a VA Merit Award for a multisite randomized controlled trial of Hospital GP4C.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/10299720


PUBLICATIONS:

Journal Articles

1. Pappas MA, Jenkins AM, Horstman MJ, Rohatgi N, Press VG, Prochaska MT, Michtalik HJ, Sigmund A, Pavon JM, Bhandari S, Gupta V, Taylor SP, Society of Hospital Medicine Research Committee. State of research in adult Hospital Medicine: Updated results of a national survey and longitudinal analysis of national data. Journal of hospital medicine. 2023 Jun 1; 18(6):519-523.