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IIR 11-343 – HSR&D Study

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IIR 11-343
Utilizing the RESCUE Stroke Caregiver Website to Enhance Discharge Planning
Constance R. Uphold PhD MS BS
North Florida/South Georgia Veterans Health System, Gainesville, FL
Gainesville, FL
Funding Period: August 2014 - April 2020

BACKGROUND/RATIONALE:
Caregiver depression is common following a family member's stroke and is a major contributor of the survivor's hospital readmission and institutionalization. Problem-solving interventions are effective in reducing caregiver depressive symptoms; however, these interventions have been underused in practice because they involve multiple sessions and are time-intensive for caregivers and staff. To overcome these barriers, our long-term goal is to implement stroke caregiver programs that involve sustainable, low-cost interventions in routine clinical practice.

OBJECTIVE(S):
Our immediate objective is to test, using a randomized controlled trial, a problem-solving intervention for stroke caregivers that can be delivered during one post-discharge telephone session followed by online, in-home sessions. We will modify the traditional problem-solving intervention by adding web-based training using interactive modules, factsheets, and tools on our previously developed and nationally available RESCUE Caregiver website (www.cidrr8.research.va.gov/rescue). We will also provide an online skills training and application of the problem-solving approach via the RESCUE messaging center, a secure site behind the VA firewall. Our immediate, primary aim (#1) is to test the effect of the intervention on stroke caregivers' depressive symptoms at approximately 11 and 19 weeks after baseline data collection. Our primary hypothesis is that the intervention group will have less depressive symptoms compared to stroke caregivers in usual care. Aim #2 is to test the effect of the intervention on stroke caregivers' stroke knowledge, burden, perceived stress, perceptions of caregiving, self-efficacy, health-related quality of life (HRQOL), and satisfaction with care at approximately 11 and 19 weeks after baseline. Aim #3 is to test the effect of the intervention on Veterans' outcomes: functional abilities and healthcare utilization at approximately 11 and 19 weeks after baseline. Aim #4 is to determine the budgetary impact for implementing the intervention. Aim #5 is to determine the facilitators, barriers and best practices for implementing the intervention.

METHODS:
We will conduct a two-group randomized controlled trial with repeated measures and use mixed methods. We will enroll 240 stroke caregivers from 8 VA sites (North Florida/South Georgia Veterans Healthcare System, Miami VA Healthcare System, James A. Haley Veterans Hospital in Tampa, Michael E. Debakey VAMC in Houston, Hunter Holmes McGuire VAMC in Richmond, Central Arkansas Veterans Healthcare System, VA Tennessee Valley Healthcare System, and the VA Boston Healthcare System). Eligible caregivers will complete baseline measures, and then be randomized to two groups: 1) intervention or 2) usual care. A study team member will telephone caregivers at approximately 11 and 19 weeks after baseline to administer instruments with established reliability and validity. We will review the Veterans' VA CPRS health record to obtain information on the Veterans' healthcare utilization. We will determine the budgetary impact of the intervention by examining the cost data in the VA Managerial Cost Accounting System (formerly Decision Support System) National Data Extracts and Non-VA Medical Care (formerly fee-basis) files. We will conduct qualitative interviews with selected caregivers to obtain in-depth perceptions of the value, facilitators, and barriers of the intervention. Throughout the project we will collaborate with our VA (Offices of Nursing Service, Office of Geriatrics and Extended Care) and non-VA partners (American Stroke Association).

FINDINGS/RESULTS:
We expect to find that, compared to the usual care group, the intervention group will show less negative effects of stress on caregivers (depressive symptoms, perceived stress, burden) and patients (functional disabilities, healthcare utilization and costs); and greater caregiver knowledge, self-efficacy, perceptions of positive aspects of caregiving, satisfaction with care, and health-related quality of life.

IMPACT:
This is the first known study to test a transition-to-home intervention combined with technology to improve the quality of caregiving and the recovery of Veterans. Other outcomes will include a state-of-the-art website and an evidence-based model (in-patient, discharge planning and online, training and caregiver-provider messaging) that can be transportable to other disease models.

PUBLICATIONS:

Journal Articles

  1. Graf R, LeLaurin J, Schmitzberger M, Freytes IM, Orozco T, Dang S, Uphold CR. The stroke caregiving trajectory in relation to caregiver depressive symptoms, burden, and intervention outcomes. Topics in Stroke Rehabilitation. 2017 Oct 1; 24(7):488-495.
Conference Presentations

  1. Uphold CR. A Caregiver Support Study Utilizing an Internet-Based Messaging Center. Paper presented at: VA Miami Geriatric Research, Education and Clinical Center Geriatric and Palliative Medicine Grand Rounds; 2016 Sep 15; Miami, FL.
  2. Uphold CR. A Caregiver Support Study Utilizing an Internet-Based Messaging Center. Paper presented at: VA Miami Veterans Affairs Medical Center PACT Seminar; 2016 Sep 14; Miami, FL.


DRA: Aging, Older Veterans' Health and Care, Health Systems, Cardiovascular Disease
DRE: none
Keywords: Caregiving, Cost-Effectiveness, Decision-Making, Home Care, Outcomes - Patient, Quality of Life, Stroke, Utilization
MeSH Terms: none