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CDA 21-143 – HSR&D Study

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CDA 21-143
Hospital GamePlan4Care: A Web-Based Delivery System for Dementia Caregiver Support
Molly Horstman MD MS
Houston, TX
Funding Period: October 2021 - September 2026

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. Horstman MJ, Evans TL, Guo C, Sonnenfeld M, Naik AD, Stevens A, Kunik ME. Needs of family caregivers of hospitalised adults with dementia during care transitions: a qualitative study in a US Department of Veterans Affairs Hospital. BMJ open. 2024 Aug 21; 14(8):e087231.
  2. Gustavson AM, Horstman MJ, Cogswell JA, Holland DE, Vanderboom CE, Mandrekar J, Harmsen WS, Kaufman BG, Ingram C, Griffin JM. Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: lessons from a randomized trial. Trials. 2024 Jul 4; 25(1):454.
  3. Razjouyan J, Orkaby AR, Horstman MJ, Goyal P, Intrator O, Naik AD. The Frailty Trajectory's Additional Edge Over the Frailty Index: Retrospective Cohort Study of Veterans With Heart Failure. JMIR aging. 2024 Jun 27; 7:e56345.
  4. Horstman MJ, Howell SA, Martini SR. Clinical progress note: Anti-amyloid monoclonal antibodies. Journal of hospital medicine. 2024 Jun 18; https://doi.org/10.1002/jhm.13434.
  5. Kim SE, Azarian M, Naik AD, Park C, Horstman MJ, Virani SS, Intrator O, Amos CI, Orkaby A, Razjouyan J. What is the additive value of nutritional deficiency to VA-FI in the risk assessment for heart failure patients? The Journal of Nutrition, Health & Aging. 2024 Jul 1; 28(7):100253.
  6. Cho J, Sands LP, Stevens AB, Allore HG, Horstman MJ. Profile of Caregiving Activities and Association With Physical Health Among Dementia Spousal Caregivers. Innovation in aging. 2024 Feb 15; 8(3):igae017.
  7. 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.
Journal Other

  1. Horstman MJ. More than dollars: Healthcare utilization among spouses of persons with dementia. [Editorial]. Journal of the American Geriatrics Society. 2024 Aug 29; DOI: 10.1111/jgs.19174.


DRA: Aging, Older Veterans' Health and Care, Health Systems Science
DRE: TRL - Development
Keywords: None at this time.
MeSH Terms: None at this time.

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