Published in:
01-10-2019 | Care | Original Research
Family Caregiver Skills Training to Improve Experiences of Care: a Randomized Clinical Trial
Published in: Journal of General Internal Medicine | Issue 10/2019
Login to get accessAbstract
Objective
To evaluate the effectiveness of Helping Invested Families Improve Veterans’ Experiences Study (HI-FIVES), a skills training program for caregivers of persons with functional or cognitive impairments.
Design
A two-arm RCT.
Setting
Single Veterans Affairs Medical Center.
Participants
Patients and their primary caregivers referred in the past 6 months to home and community-based services or geriatrics clinic.
Intervention
All caregivers received usual care. Caregivers in HI-FIVES also received five training calls and four group training sessions.
Main Measures
Cumulative patient days at home 12 months post-randomization, defined as days not in an emergency department, inpatient hospital, or post-acute facility. Secondary outcomes included patients’ total VA health care costs, caregiver and patient rating of the patient’s experience of VA health care, and caregiver depressive symptoms.
Results
Of 241 dyads, caregivers’ (patients’) mean age was 61 (73) years, 54% (53%) Black and 89% (4%) female. HI-FIVES was associated with a not statistically significant 9% increase in the rate of days at home (95% CI 0.72, 1.65; mean difference 1 day over 12 months). No significant differences were observed in health care costs or caregiver depressive symptoms. Model-estimated mean baseline patient experience of VA care (scale of 0–10) was 8.43 (95% CI 8.16, 8.70); the modeled mean difference between HI-FIVES and controls at 3 months was 0.29 (p = .27), 0.31 (p = 0.26) at 6 months, and 0.48 (p = 0.03) at 12 months. For caregivers, it was 8.34 (95% CI 8.10, 8.57); the modeled mean difference at 3 months was 0.28 (p = .18), 0.53 (p < .01) at 6 months, and 0.46 (p = 0.054) at 12 months.
Conclusions
HI-FIVES did not increase patients’ days at home; it showed sustained improvements in caregivers’ and patients’ experience of VA care at clinically significant levels, nearly 0.5 points. The training holds promise in increasing an important metric of care quality—reported experience with care.