Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, HSRD 152, 508 Fulton Street, Durham, NC, 27705, USA.
Department of Population Health Sciences, School of Medicine, Duke University Medical Center, Durham, NC, USA.
J Gen Intern Med. 2019 Oct;34(10):2114-2122. doi: 10.1007/s11606-019-05209-x. Epub 2019 Aug 6.
To evaluate the effectiveness of Helping Invested Families Improve Veterans' Experiences Study (HI-FIVES), a skills training program for caregivers of persons with functional or cognitive impairments.
A two-arm RCT.
Single Veterans Affairs Medical Center.
Patients and their primary caregivers referred in the past 6 months to home and community-based services or geriatrics clinic.
All caregivers received usual care. Caregivers in HI-FIVES also received five training calls and four group training sessions.
Cumulative patient days at home 12 months post-randomization, defined as days not in an emergency department, inpatient hospital, or post-acute facility. Secondary outcomes included patients' total VA health care costs, caregiver and patient rating of the patient's experience of VA health care, and caregiver depressive symptoms.
Of 241 dyads, caregivers' (patients') mean age was 61 (73) years, 54% (53%) Black and 89% (4%) female. HI-FIVES was associated with a not statistically significant 9% increase in the rate of days at home (95% CI 0.72, 1.65; mean difference 1 day over 12 months). No significant differences were observed in health care costs or caregiver depressive symptoms. Model-estimated mean baseline patient experience of VA care (scale of 0-10) was 8.43 (95% CI 8.16, 8.70); the modeled mean difference between HI-FIVES and controls at 3 months was 0.29 (p = .27), 0.31 (p = 0.26) at 6 months, and 0.48 (p = 0.03) at 12 months. For caregivers, it was 8.34 (95% CI 8.10, 8.57); the modeled mean difference at 3 months was 0.28 (p = .18), 0.53 (p < .01) at 6 months, and 0.46 (p = 0.054) at 12 months.
HI-FIVES did not increase patients' days at home; it showed sustained improvements in caregivers' and patients' experience of VA care at clinically significant levels, nearly 0.5 points. The training holds promise in increasing an important metric of care quality-reported experience with care.
评估 Helping Invested Families Improve Veterans' Experiences Study（HI-FIVES）的效果，这是一项针对有功能或认知障碍患者照顾者的技能培训计划。
双臂 RCT。
单家退伍军人事务医疗中心。
过去 6 个月内被转介至家庭和社区服务或老年病诊所的患者及其主要照顾者。
所有照顾者均接受常规护理。HI-FIVES 组的照顾者还接受了五次培训电话和四次小组培训。
随机分组后 12 个月内患者在家中的累计天数，定义为未在急诊、住院或康复机构的天数。次要结局包括患者的 VA 医疗总费用、照顾者和患者对 VA 医疗体验的评分，以及照顾者的抑郁症状。
在 241 对患者-照顾者中，照顾者（患者）的平均年龄为 61（73）岁，54%（53%）为黑人，89%（4%）为女性。HI-FIVES 组患者在家中的天数增加了 9%，但未达到统计学显著差异（95%CI 0.72，1.65；平均差异为 12 个月内 1 天）。VA 医疗费用或照顾者的抑郁症状没有显著差异。模型估计的基线患者 VA 医疗体验平均得分（0-10 分制）为 8.43（95%CI 8.16，8.70）；HI-FIVES 组与对照组在 3 个月时的平均差异为 0.29（p=0.27），在 6 个月时为 0.31（p=0.26），在 12 个月时为 0.48（p=0.03）。对于照顾者，其平均得分（95%CI 8.10，8.57）为 8.34；3 个月时的平均差异为 0.28（p=0.18），6 个月时为 0.53（p<0.01），12 个月时为 0.46（p=0.054）。
HI-FIVES 并未增加患者在家中的天数；但在临床上显著水平（近 0.5 分）上持续改善了照顾者和患者对 VA 医疗的体验。该培训在提高护理质量的一个重要指标（即患者对护理的体验）方面具有潜力。
