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A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.

Publication ,  Journal Article
Van Houtven, CH; Coffman, CJ; Decosimo, K; Grubber, JM; Dadolf, J; Sullivan, C; Tucker, M; Bruening, R; Sperber, NR; Stechuchak, KM; Boucher, N ...
Published in: Health Serv Res
August 13, 2024

OBJECTIVE: To assess the effects of an evidence-based family caregiver training program (implementation of Helping Invested Families Improve Veteran Experiences Study [iHI-FIVES]) in the Veterans Affairs healthcare system on Veteran days not at home and family caregiver well-being. DATA SOURCES AND STUDY SETTING: Participants included Veterans referred to home- and community-based services with an identified caregiver across 8 medical centers and confirmed family caregivers of eligible Veterans. STUDY DESIGN: In a stepped wedge cluster randomized trial, sites were randomized to a 6-month time interval for starting iHI-FIVES and received standardized implementation support. The primary outcome, number of Veteran "days not at home," and secondary outcomes, changes over 3 months in measures of caregiver well-being, were compared between pre- and post-iHI-FIVES intervals using generalized linear models including covariates. DATA COLLECTION/EXTRACTION METHODS: Patient data were extracted from the electronic health record. Caregiver data were collected from 2 telephone-based surveys. PRINCIPAL FINDINGS: Overall, n = 898 eligible Veterans were identified across pre-iHI-FIVES (n = 327) and post-iHI-FIVES intervals (n = 571). Just under one fifth (17%) of Veterans in post-iHI-FIVES intervals had a caregiver enroll in iHI-FIVES. Veteran and caregiver demographics in pre-iHI-FIVES intervals were similar to those in post-iHI-FIVES intervals. In adjusted models, the estimated rate of days not at home over 6-months was 42% lower (rate ratio = 0.58 [95% confidence interval: 0.31-1.09; p = 0.09]) post-iHI-FIVES compared with pre-iHI-FIVES. The estimated mean days not at home over a 6-month period was 13.0 days pre-iHI-FIVES and 7.5 post-iHI-FIVES. There were no differences between pre- and post-iHI-FIVES in change over 3 months in caregiver well-being measures. CONCLUSIONS: Reducing days not at home is consistent with effectiveness because more time at home increases quality of life. In this study, after adjusting for Veteran characteristics, we did not find evidence that implementation of a caregiver training program yielded a reduction in Veteran's days not at home.

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Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

August 13, 2024

Location

United States

Related Subject Headings

  • Health Policy & Services
  • 4407 Policy and administration
  • 4203 Health services and systems
  • 1605 Policy and Administration
  • 1117 Public Health and Health Services
 

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Van Houtven, C. H., Coffman, C. J., Decosimo, K., Grubber, J. M., Dadolf, J., Sullivan, C., … Hastings, S. N. (2024). A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program. Health Serv Res. https://doi.org/10.1111/1475-6773.14326
Van Houtven, Courtney Harold, Cynthia J. Coffman, Kasey Decosimo, Janet M. Grubber, Joshua Dadolf, Caitlin Sullivan, Matthew Tucker, et al. “A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.Health Serv Res, August 13, 2024. https://doi.org/10.1111/1475-6773.14326.
Van Houtven CH, Coffman CJ, Decosimo K, Grubber JM, Dadolf J, Sullivan C, et al. A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program. Health Serv Res. 2024 Aug 13;
Van Houtven, Courtney Harold, et al. “A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program.Health Serv Res, Aug. 2024. Pubmed, doi:10.1111/1475-6773.14326.
Van Houtven CH, Coffman CJ, Decosimo K, Grubber JM, Dadolf J, Sullivan C, Tucker M, Bruening R, Sperber NR, Stechuchak KM, Shepherd-Banigan M, Boucher N, Ma JE, Kaufman BG, Colón-Emeric CS, Jackson GL, Damush TM, Christensen L, Wang V, Allen KD, Hastings SN. A stepped wedge cluster randomized trial to evaluate the effectiveness of a multisite family caregiver skills training program. Health Serv Res. 2024 Aug 13;
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

August 13, 2024

Location

United States

Related Subject Headings

  • Health Policy & Services
  • 4407 Policy and administration
  • 4203 Health services and systems
  • 1605 Policy and Administration
  • 1117 Public Health and Health Services