Transcript Care Consultation - Ohio Association of Gerontology and

“Evidence-Based Programs for
Caregiving Families”
Annual Conference
Ohio Association of Gerontology and Education
4-15-11
David M. Bass, PhD
Vice President for Research
Margaret Blenkner Research Institute
1
History of Family Caregiving Research
• 30 years of caregiving research
– First 15 years, most research on prevalence,
consequences, and predictors
• Recent 15 years, more research on
interventions
– Education and training; counseling and
support; multi-component interventions
• Desired intervention caregiver outcomes
– Reduced depression, anxiety, health problems,
care-related strains; increased efficacy
• Desired intervention care receiver outcomes
– Reduced symptoms, strain, health care service
use and cost; improved quality of care
2
Interventions as Evidence-Based
Caregiving Programs
• Some interventions became “evidence-based
programs”
• Definition of evidence-based
– Tested in a randomized controlled trial
– Statistically significant improvement in
outcomes
– Proven efficacy-(not effectiveness or feasibility)
– High internal validity-(not external validity)
– Published in peer reviewed journals
• Rosalynn Carter Institute identified over 70
interventions that are evidence-based
– BRI Care Consultation was one
3
BRI Care Consultation:
An Evidence-Based Program
• Telephone and computer support service
• Framework-standardized components but
personalized content
• Empower consumers for self-management
• Simple and practical solutions
• Not disease or severity specific
• Equal attention to Care Receivers and
Caregivers
• Long-term relationship with clients
• A way of doing care coordination
• Immediate problems and crisis prevention
4
Care Consultation Research Studies
1. Cleveland Alzheimer’s Managed Care Demon., 1997-2001
2. Chronic Care Networks for Alzheimer’s Disease, 1998-2004
3. Partners in Dementia Care for Veterans with Dementia and
Their Family Caregivers, 2006-2011
4. Integrated Care Management, 2005-2007
5. Care Network for Depression, 2006-2009
6. Care Consultation in Cleveland, 2009-2011
7. Tennessee Replication of Care Consultation, 2009-2012
8. The Georgia Care Consultation Program, 2010-2013
5
Four Types of Assistance Provided
1. Health & Care-Related Information
2. Family & Friend Involvement
3. Awareness & Use Community Services
4. Coaching & Emotional Support
6
Outcomes Impacted by Care Consultation
Psychosocial Outcomes-Caregivers and Care Receivers
• Decreased depression
• Decreased emotional strain, isolation, relationship strain,
physical health strain
• Decreased unmet needs related to: health and caregiving
information, access to services, legal/financial, medical
care, emotional support
• Improved informal support
Utilization Outcomes-Care Receivers
• Decreased hospital admissions and ED visits
• Delayed nursing home placement
• Increased satisfaction with care
• Increased use of primary care, outpatient services, and
community services
7
Gaps in EBP Caregiving Research
• Need for effectiveness vs. efficacy research
– Larger samples
– More representative samples
– Multiple sites
– Comparative effectiveness
• Proven intervention feasibility
– Large representative samples
– Testing whether interventions can go to scale
– Fidelity to original model
– Can providers deliver it?
• Proven intervention acceptability
– Will consumers use it?
• Long-term sustainability
8
– Will someone pay for it?
Develop “Implementation Science”
What variables explain implementation
success and sustainability?
• Multiple levels of variables
– Evidence-based program characteristics
– Consumer characteristics
– Service provider characteristics
– Organizational characteristics
– Community characteristics
9
Model for Implementation of EvidenceBased Programs
10
Evidence-Based Program (EBP) Characteristics
• Strength of Research Evidence
– Efficacy, effectiveness, feasibility, and/or acceptability
– Type of study design
– Impact on outcomes-statistical vs. clinical significance
– Understanding selection bias and attrition
• Manuals & Fidelity
– Standardized prescriptive protocol
– Comprehensive manuals
– Recordkeeping tools and information systems
– Fidelity monitoring tools
• Staffing & Training
– Required academic background
– Prerequisite skills & experience
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– Quality of EBP training curriculum
Parent Organization Characteristics & EBP
• Mission and Reputation
– Consistency of EBP with organization mission
– Culture for innovation and business planning
– Experience and reputation serving EBP target
population
• Internal Buy-In
– Influential internal champion
– High level administrative support
– Broad-base of staff support
• Organizational Resources
– Ability/Willingness to make upfront financial investment
– Skill set and expertise among existing staff
– EBP fit within organization hierarchy and other services
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– Adequate physical resources and environment
Community Characteristics & EBP
• Payment Source for EBP
– Third party reimbursement
– Pricing structure for consumers and/or organizations
• Target Populations
– Target population clearly delineated and known
– Size of target population and scale of implementation
• Competitors and Partners
– Distinctiveness of EBP from other products and services
– Size of client population not being served by others
– Extent of competition for clients and resources
– Strategic partnerships for enrollment and legitimacy
• Marketing
– Addressing consumer predisposing, enabling, & need
13
– Advertising
Model for Implementation of
Evidence-Based Programs
14