The purpose of the proposed project is to increase health systems capacity to make the HOBSCOTCH (Home Based Self-Management and COgnitive Training CHanges Lives) program accessible to people with epilepsy (PWE) and cognitive dysfunction and the clinicians who care for them. We will utilize a scalable HUB and SPOKE organizational design which supports diverse clinical site adoption and standardized referral pathways. For evidence based epilepsy self-management (ESM) programs to be translated from science to service delivery a process of local adaptation that serves to increase the relevance and meaning to patients, providers and practices will be required.
HOBSCOTCH is an evidence-based ESM which targets cognitive dysfunction in adults with epilepsy. The program is delivered by a trained Cognitive Coach (psychologist, APRN), one-to one, by telehealth incorporating online and telephone components. It is designed to assist PWE manage and cope with their cognitive problems in order to lead happier more productive lives. The HOBSCOTCH intervention, at baseline, represents an innovative way of addressing neurocognitive difficulties and improving quality of life in people with epilepsy.
The proposed project builds on the foundational work of the HOBSCOTCH Institute, by bringing together a network of partners committed to improving the lives PWE. The project will target building streamlined mechanisms for provider engagement, adoption support and patient referral to HOBSCOTCH in two clinical settings. The first setting, diverse US epilepsy centers with clinicians and researchers with expertise in epilepsy care in 14 states (NC, MA, CA, GA, ME, FL, AZ, MN, CT, OH, PA, NH, TX, MO) and the second setting, a Northern New England Cooperative of community and family medicine network of practices caring for people with epilepsy in rural and underserved areas.
The framework for the project supports the goals and intent of the CDC’s Building Capacity for Implementing Evidence-based Epilepsy Self-management Supports in Health Care Settings (Component 1) by utilizing the combined resources and depth of expertise at the HOBSCOTCH Institute, Dartmouth Health, The Dartmouth Institute and Dartmouth College to develop partnerships with healthcare organizations and other interested and affected groups for intervention implementation, and to coordinate and implement evidence-based epilepsy self-management supports using best practice strategies for health system change. Our approach will be collaborative with a robust central HUB of support being the HOBSCOTCH Institute, and the SPOKES increasing our potential to address disparities through ESM support that reaches rural, urban, disadvantaged and underserved communities, and people with epilepsy across the lifespan and those with comorbid disabilities.
Project outcomes will include improved awareness of telehealth deliverable self-management supports for health professionals and PWE, increased provider referrals for evidence-based ESM HOBSCOTCH, increased implementation of HOBSCOTCH in clinical settings, increased use of quality improvement strategies or tools to ensure effective program access and implementation, improved completion of evidence-based ESM supports among PWE and cognitive dysfunction, improved quality of life and health outcomes for PWE and cognitive dysfunction, decreased health care utilization costs and increased use of appropriate community supports. This project has potential for replicable models in primary care and at epilepsy centers to emerge, and shares an innovative model that engages psychology training programs to grow sustainability.