Because the majority of Medicare expenditures involve repeated and often preventable hospitalizations for chronic conditions like CHF and COPD, private-sector disease management organizations are increasingly offering telephonic support to seniors with these conditions. In order to improve care coordination, call center coaches need materials to help elder caregivers in their roles as adherence facilitators for both the patient and themselves. This project will develop and evaluate a multi-level Web-based content delivery system to: (a) train call center coaches on caregiver issues, (b) facilitate coaches'assessment of caregiver-specific needs, and (c) requisition tailored low-literacy follow-up media for the caregiver in a variety of formats (DVD-video, 4th grade reading level print and PDF). The system will integrate with existing call center applications to help coaches address the domains of disease management, care plan adherence, personal coping with the caregiver role, and caregiver self-care. In Phase I, this project will focus on caregivers of individuals with Congestive Heart Failure (CHF);in Phase II the focus will be expanded to include caregivers of individuals with Chronic Obstructive Pulmonary Disorder (COPD). This revision application is submitted in response to NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (NOT-OD-09-058). It directly addresses: (a) the goals of the ARRA legislation, and (b) the primary concern of the parent Phase I application reviewers: """""""" """"""""The most salient limitation is that the evaluation study does not really assess the main and most promising component of the intervention - the call center interactions and coaching."""""""" The parent Phase I application involves the production and evaluation of caregiver educational materials on CHF. In response to reviewer concerns, this revision Phase I application will create and evaluate a prototype of the system's complementary training and coaching components. Thus, this project will accelerate the research by testing the feasibility of both program components, allowing reviewers of the Phase II application to more clearly assess the feasibility of the overall program. In addition, this revision will provide considerable ARRA funding to support part-time/under-supported research personnel. The efficacy of the prototype call center component will be evaluated with 40 call center coaches using a within-subject pre-post test design. Outcomes include knowledge self-efficacy, motivation, perceived utility, and user satisfaction. Lessons learned in Phase I of both the parent and revision projects will be applied in Phase II, improving the quality of the program. Phase II will expand the caregiver materials to cover all domains, adding caregiver and call center materials on COPD and caregiver self-care/coping, as well as product promotional materials. In Phase II, the complete program will undergo a large-scale randomized clinical trial involving elder caregivers, and a process and outcome evaluation of the call center staff.
Elder caregivers are an integral part of the health care team, facilitating care plan adherence and enabling independent living. In addition, as seniors themselves, they have their own health challenges, which are often exacerbated by their caregiving role. This program is designed to assist disease management call center coaches in offering state-of-the-art support to elder caregivers in the domains of disease management skills, care plan adherence, caregiver coping, and caregiver self-care, including low literacy follow-up materials available on DVD-video, or as hard copy or e-mail articles.
