The Role of Visit Audio Recordings in Triadic Dementia Care
Project Number5R01AG077113-03
Contact PI/Project LeaderBARR, PAUL JAMES Other PIs
Awardee OrganizationDARTMOUTH COLLEGE
Description
Abstract Text
PROJECT SUMMARY
One in nine people aged 65 or older in the US lives with Alzheimer's disease (AD) or Alzheimer's disease-related
dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits
for dementia information, management, and community referrals. Quality interpersonal communication is
associated with improved health-related outcomes. Models of triadic interactions purport that information
exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to
effective interpersonal communication. However, the degree to which effective interpersonal communication is
achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of
clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application
is unexplored in dementia. The objective of this proposal is to design an intervention that enhances interpersonal
communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their
visit recording platform, HealthPAL, which leverages natural language processing to structure visit information.
The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of
200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between
interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and
enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to
enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the
usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD. Applicants hypothesize:
1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2)
HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants
will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for
behavior change will be identified using quantitative assessment of interpersonal communication during triadic
visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive
sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL
using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to
determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on
interpersonal communication in triadic AD/ADRD visits. This work is a necessary first step to improving PLWD
triadic care by identifying behaviors that impact interpersonal communication and their associations with health-
related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful
resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.
Public Health Relevance Statement
PROJECT NARRATIVE
Effective interpersonal communication is associated with improved health related outcomes, yet it is unclear to
what extent this occurs in triadic clinic visits in dementia, and few tools exist to support it. The objective of this
project is to characterize the extent to which interpersonal communication occurs during triadic visits in
dementia, examine how this is related to health outcomes and use this understanding to adapt an innovative
clinic visit audio recording intervention, HealthPAL for use in this setting. The results are expected to have a
major positive impact by providing a rich understanding of communication during triadic visits in dementia, and
proof-of-principle of the usability, feasibility, and acceptability of visit audio recording to enhance interpersonal
communication.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AccountabilityAddressAdherenceAlzheimer's DiseaseAlzheimer's disease related dementiaAmbulatory Care FacilitiesBehaviorCaringClinic VisitsClinicalCommunicationCommunitiesComputer softwareDataDecision MakingDementiaEffectivenessEmotionalEthnic OriginExclusionFamilyFederally Qualified Health CenterFeedbackFundingFutureGeographyGoalsHealthHealth ServicesInterventionInterviewKnowledgeLebanonLinguisticsMapsMethodsModelingMotivationNatural Language ProcessingObservational StudyOutcomePatient CarePatient PreferencesPatientsPerformancePersonal CommunicationPersonsPlayPrimary CareProcessProviderQuality of lifeRaceReadinessRecommendationReportingResearchResourcesRoleRoterSamplingScheduleSiteStructureSystemSystems AnalysisTechniquesTrustUnited States National Institutes of HealthVisitWorkacceptability and feasibilityagedarmbehavior changebehavior change wheelcognitive loaddementia caredesignevidence baseexperiencefollow-uphuman old age (65+)improvedimproved outcomeinformation processinginnovationnovelopen labelpilot trialprimary care clinicprospectivepsychosocialrural health clinicsatisfactionskillssoftware developmenttheoriestherapy designtooltrustworthinessusability
No Sub Projects information available for 5R01AG077113-03
Publications
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Outcomes
The Project Outcomes shown here are displayed verbatim as submitted by the Principal Investigator (PI) for this award. Any opinions, findings, and conclusions or recommendations expressed are those of the PI and do not necessarily reflect the views of the National Institutes of Health. NIH has not endorsed the content below.
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