School of Medicine, Johns Hopkins University, USA.
School of Medicine, Johns Hopkins University, USA.
Contemp Clin Trials. 2018 Aug;71:103-112. doi: 10.1016/j.cct.2018.05.009. Epub 2018 May 18.
Dementia is associated with high health care costs, premature long-term care (LTC) placement, medical complications, reduced quality of life, and caregiver burden. Most health care providers and systems are not yet organized or equipped to provide comprehensive long-term care management for dementia, although a range of effective symptoms and supportive care approaches exist. The Maximizing Independence at Home-Streamlined (MIND-S) is a promising model of home-based dementia care coordination designed to efficiently improve person-centered outcomes, while reducing care costs. This report describes the rationale and design of an NIA-funded randomized controlled trial to test the impact of MIND-S on time to LTC placement, person with dementia outcomes (unmet needs, behavior, quality of life), family caregiver outcomes (unmet needs, burden), and cost offset at 18 (primary end point) and 24 months, compared to an augmented usual care group.
This is a 24-month, parallel group, randomized trial evaluating MIND-S in a cohort of 304 community-living persons with dementia and their family caregivers in Maryland. MIND-S dyads receive 18 months of care coordination by an interdisciplinary team comprised of trained non-clinical community workers (e.g. Memory Care Coordinators), a registered nurse, and a geriatric psychiatrist. Intervention components include in-home dementia-related needs assessments; individualized care planning; implementation of standardized evidence-based care strategy protocols; and ongoing monitoring and reassessment. Outcomes are assessed by blinded evaluators at baseline, 4.5, 9, 13.5, 18, and 24 months.
Trial results will provide rigorous data to inform innovations in effective system-level approaches to dementia care.
痴呆症与高医疗保健费用、过早的长期护理（LTC）安置、医疗并发症、生活质量下降以及照顾者负担有关。尽管存在一系列有效的症状和支持性护理方法，但大多数医疗保健提供者和系统尚未组织或配备来提供全面的痴呆症长期护理管理。“最大限度地提高家庭独立性-简化版（MIND-S）”是一种有前途的家庭为基础的痴呆症护理协调模式，旨在有效地改善以患者为中心的结果，同时降低护理成本。本报告描述了一项由 NIA 资助的随机对照试验的基本原理和设计，该试验旨在测试 MIND-S 对 LTC 安置时间、痴呆患者结果（未满足的需求、行为、生活质量）、家庭照顾者结果（未满足的需求、负担）以及与增强型常规护理组相比，在 18（主要终点）和 24 个月的成本节省的影响。
这是一项为期 24 个月、平行组、随机试验，评估了马里兰州 304 名居住在社区的痴呆症患者及其家庭照顾者中的 MIND-S。MIND-S 对接受了 18 个月的跨学科团队护理协调，该团队由经过培训的非临床社区工作者（例如记忆护理协调员）、注册护士和老年精神病学家组成。干预措施包括家庭痴呆相关需求评估；个性化护理计划；实施标准化的循证护理策略方案；以及持续监测和重新评估。通过盲法评估员在基线、4.5、9、13.5、18 和 24 个月时评估结果。
试验结果将提供严格的数据，为有效的系统层面的痴呆症护理创新提供信息。
