Pilot Study of Hospital GamePlan4Care

Description

The efficacy of support interventions designed for caregivers of adults with dementia and delivered as part of hospital care has not been established. Hospital GamePlan4Care is a new intervention that has been developed and tested with feedback from caregivers and health professionals. Hospital GamePlan4Care was feasible to implement during hospital care and acceptable to caregivers in a single-arm feasibility and acceptability pilot. There are no prior caregiver support interventions that include the same population (caregivers of adults with dementia), intervention delivery mechanism (web-based intervention), and practice setting (intervention started in the hospital and continued following discharge) to estimate effect sizes for a large randomized control trial of Hospital GamePlan4Care.This study will be a pilot single-blind randomized study comparing Hospital GamePlan4Care (intervention arm) to a Health Education Control arm (Caregiver Education). Caregivers will be assigned to the intervention or control arm in a ratio of 1:1. Each arm will continue for three months after the Veteran is discharged from the hospital.

Caregivers of adults with dementia will be recruited while the Veteran they care for is hospitalized. The research coordinator will complete the informed consent with the caregiver before the Veteran is discharged. All enrolled caregivers will receive a VA Care Transitions handbook. Following baseline data collection, enrolled caregivers will be randomized to Hospital GamePlan4Care or Caregiver Education arm in a 1:1 ratio using the randomization feature in VA REDCap. All Veterans and caregivers will receive standard hospital discharge planning and post-discharge care. A standard hospital discharge includes a consultation with an inpatient social worker or case manager, inpatient medication reconciliation, patient-centered written discharge instructions, a post-discharge phone call from the Veteran’s primary care clinic, and scheduled follow-up appointments. The primary outcomes are caregiver-reported and will be measured 30 days and 90 days after hospital discharge.

Caregivers randomized to Hospital GamePlan4Care will receive 1) access to the Hospital GamePlan4Care website that includes training content relevant to caregivers during care transitions, such as learning how to complete new medical tasks, managing delirium, and addressing dementia behaviors, 2) 11 automated emails after hospital discharge that highlight Hospital GamePlan4Care training content and encourage caregivers to log into the website, and 3) four scheduled contacts with a Dementia Care Specialist after hospital discharge to tailor the intervention to the caregivers needs. Scheduled contacts with the Dementia Care Specialist will be on Day 2, Day 14, Day 28, and Day 60 after discharge.

Caregivers randomized to Caregiver Education will receive: 1) four automated emails after hospital discharge with recommended resources from the Home Alone Alliance, which provides high-quality training videos for caregivers, and 2) four scheduled phone calls with the Dementia Care Specialist after hospital discharge to confirm the emails were received and to see if the caregiver has any questions about the materials. Emails will be sent on Day 2, Day 14, Day 28, and Day 60 after discharge, and phone calls will be made after each email is sent.

The results from this study will inform the feasibility and sample size calculation for a multisite randomized controlled trial to test the efficacy of Hospital GP4C to improve caregiver-reported outcomes.