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Ilkhani S, Comrie CE, Pinkes N, Zier CL, Gaudino SG, Slavin MD, Kazis LE, Ryan CM, Schneider JC, Livingston DH, Salim A, Anderson GA, Herrera-Escobar JP. Beyond surviving: A scoping review of collaborative care models to inform the future of postdischarge trauma care. J Trauma Acute Care Surg 2024; 97:e41-e52. [PMID: 38720203 PMCID: PMC11424261 DOI: 10.1097/ta.0000000000004384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
ABSTRACT Trauma centers demonstrate an impressive ability to save lives, as reflected by inpatient survival rates of more than 95% in the United States. Nevertheless, we fail to allocate sufficient effort and resources to ensure that survivors and their families receive the necessary care and support after leaving the trauma center. The objective of this scoping review is to systematically map the research on collaborative care models that have been put forward to improve trauma survivorship. Of 833 articles screened, we included 16 studies evaluating eight collaborative care programs, predominantly in the United States. The majority of the programs offered care coordination and averaged 9 months in duration. Three fourths of the programs incorporated a mental health provider within their primary team. Observed outcomes were diverse: some models showed increased engagement (e.g., Center for Trauma Survivorship, trauma quality-of-life follow-up clinic), while others presented mixed mental health outcomes and varied results on pain and health care utilization. The findings of this study indicate that collaborative interventions may be effective in mental health screening, posttraumatic stress disorder and depression management, effective referrals, and improving patient satisfaction with care. A consensus on core elements and cost-effectiveness of collaborative care models is necessary to set the standard for comprehensive care in posttrauma recovery.
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Affiliation(s)
- Saba Ilkhani
- From the Center for Surgery and Public Health (S.I., C.E.C., N.P., C.L.Z., G.A.A., J.P.H.-E.), Division of Trauma, Burn, and Surgical Critical Care (S.I., N.P., A.S., G.A.A., J.P.H.-E.), Brigham and Women's Hospital, and Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation (S.G.G., J.C.S.), Harvard Medical School; Boston University School of Public Health (M.D.S., L.E.K.); Massachusetts General Hospital (C.M.R.); Shriners Hospital for Children (C.M.R.), Harvard Medical School, Boston, Massachusetts; and Department of Surgery (D.H.L.), Division of Trauma and Critical Care, Rutgers-New Jersey Medical School, Newark, New Jersey
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Sawan M, Clough A, Mirzaei A, Widjaja GJ, Schneider C, Jeon YH, Chen T, Hilmer SN, Gnjidic D. The Carer Assessment of MedicaTion Management GuidanCe for People With Dementia at Hospital Discharge (CATCH) Tool: Exploratory Factor Analysis. Alzheimer Dis Assoc Disord 2024; 38:59-64. [PMID: 38300882 DOI: 10.1097/wad.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE The Carer Assessment of medicaTion management guidanCe for people with dementia at Hospital discharge (CATCH) tool was developed to examine the carer's experiences of medication management guidance delivery at discharge. This study explored its factor structure, characterized carers' experiences at discharge, and identified predictors of carer preparedness to manage medications at discharge. METHODS A cross-sectional survey of carers across Australia was distributed. Survey responses were analyzed descriptively, and exploratory factor and regression analyses were performed. RESULTS A total of 185 survey responses were completed. Exploratory factor analysis revealed 2 factors in the CATCH tool: (1) shared and supported decision-making in medication management (16 items loading 0.47 to 0.93); 2) provision of medication management guidance that is easy to understand (4 items loading (0.48 to 0.82). Internal consistency was acceptable (Cronbach alpha >0.8). Almost 18% of participants stated that they were not included in decisions about medications for people with dementia. The carer reported that the measure of how guidance is provided was positively related to their confidence in the management of medications postdischarge and satisfaction ( P < 0.05 for both). CONCLUSIONS The CATCH tool can give the patient and carer an opportunity to provide feedback on key elements of medication management guidance delivered at discharge.
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Affiliation(s)
| | | | | | | | | | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | | | - Sarah N Hilmer
- Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
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Mehta J, Williams C, Holden RJ, Taylor B, Fowler NR, Boustani M. The methodology of the Agile Nudge University. FRONTIERS IN HEALTH SERVICES 2023; 3:1212787. [PMID: 38093811 PMCID: PMC10716213 DOI: 10.3389/frhs.2023.1212787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/10/2023] [Indexed: 02/01/2024]
Abstract
Introduction The Agile Nudge University is a National Institute on Aging-funded initiative to engineer a diverse, interdisciplinary network of scientists trained in Agile processes. Methods Members of the network are trained and mentored in rapid, iterative, and adaptive problem-solving techniques to develop, implement, and disseminate evidence-based nudges capable of addressing health disparities and improving the care of people living with Alzheimer's disease and other related dementias (ADRD). Results Each Agile Nudge University cohort completes a year-long online program, biweekly coaching and mentoring sessions, monthly group-based problem-solving sessions, and receives access to a five-day Bootcamp and the Agile Nudge Resource Library. Discussion The Agile Nudge University is evaluated through participant feedback, competency surveys, and tracking of the funding, research awards, and promotions of participating scholars. The Agile Nudge University is compounding national innovation efforts in overcoming the gaps in the ADRD discovery-to-delivery translational cycle.
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Affiliation(s)
- Jade Mehta
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Christopher Williams
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
| | - Richard J. Holden
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Department of Health and Wellness Design, School of Public Health - Bloomington, Indiana University, Bloomington, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Britain Taylor
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Nicole R. Fowler
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, School of Medicine, Indiana University, Indianapolis, IN, United States
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, United States
- Department of Medicine, School of Medicine, Indiana University, Indianapolis, IN, United States
- Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN, United States
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Bag Soytas R, Levinoff EJ, Smith L, Doventas A, Morais JA, Veronese N, Soysal P. Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review. EPIDEMIOLOGIA 2023; 4:382-407. [PMID: 37873884 PMCID: PMC10594531 DOI: 10.3390/epidemiologia4040035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.
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Affiliation(s)
- Rabia Bag Soytas
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Elise J. Levinoff
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey;
| | - José A. Morais
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90133 Palermo, Italy;
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34320, Turkey;
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Leggett AN, Koo HJ, Strominger J, Maust DT. Gatekeepers: The Association of Caregiving Network Characteristics With Emergency Department Use by Persons Living With Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:1073-1084. [PMID: 36562342 PMCID: PMC10214653 DOI: 10.1093/geronb/gbac198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Caregivers are typically enmeshed in networks of family and friends who assist with care, yet this network is largely neglected in research. In light of the fact that caregivers are key medical decision makers and play a critical role in how persons living with dementia (PLwDs) interface with the health care system, this study explores how features of the caregiver network relate to PLwD emergency department (ED) use. METHODS Using 2015 National Health and Aging Trends Study data linked with fee-for-service Medicare claims, we examine ED use in a nationally representative sample of community-dwelling persons aged 65 and older with dementia and at least 1 caregiver. We consider aspects of the caregiver network including membership (e.g., daughter in network), network size, hours of care received, and the presence of generalists and specialists (i.e., broad vs narrow functional assistance) as predictors of ED encounters among PLwD. RESULTS PLwDs were 81.5 years old on average, 50% were female, and 33% were non-White. Care networks including nonimmediate family members involved in task sharing for mobility and self-care difficulties and those with more generalists had significantly higher odds of an ED visit. Networks that only consisted of specialist caregivers had significantly lower odds of an ED visit. DISCUSSION Greater complexity of care networks increases risk of presenting to the ED for care. Better understanding how caregiving networks help PLwD interact with the health care system can inform intervention design and targeting in order to help care networks improve care coordination, management, and shared decision making.
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Affiliation(s)
- Amanda N Leggett
- Institute of Gerontology & Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Hyun Jung Koo
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julie Strominger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Donovan T Maust
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Gogishvili D, Vromen EM, Koppes-den Hertog S, Lemstra AW, Pijnenburg YAL, Visser PJ, Tijms BM, Del Campo M, Abeln S, Teunissen CE, Vermunt L. Discovery of novel CSF biomarkers to predict progression in dementia using machine learning. Sci Rep 2023; 13:6531. [PMID: 37085545 PMCID: PMC10121677 DOI: 10.1038/s41598-023-33045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/06/2023] [Indexed: 04/23/2023] Open
Abstract
Providing an accurate prognosis for individual dementia patients remains a challenge since they greatly differ in rates of cognitive decline. In this study, we used machine learning techniques with the aim to identify cerebrospinal fluid (CSF) biomarkers that predict the rate of cognitive decline within dementia patients. First, longitudinal mini-mental state examination scores (MMSE) of 210 dementia patients were used to create fast and slow progression groups. Second, we trained random forest classifiers on CSF proteomic profiles and obtained a well-performing prediction model for the progression group (ROC-AUC = 0.82). As a third step, Shapley values and Gini feature importance measures were used to interpret the model performance and identify top biomarker candidates for predicting the rate of cognitive decline. Finally, we explored the potential for each of the 20 top candidates in internal sensitivity analyses. TNFRSF4 and TGF [Formula: see text]-1 emerged as the top markers, being lower in fast-progressing patients compared to slow-progressing patients. Proteins of which a low concentration was associated with fast progression were enriched for cell signalling and immune response pathways. None of our top markers stood out as strong individual predictors of subsequent cognitive decline. This could be explained by small effect sizes per protein and biological heterogeneity among dementia patients. Taken together, this study presents a novel progression biomarker identification framework and protein leads for personalised prediction of cognitive decline in dementia.
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Affiliation(s)
- Dea Gogishvili
- Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Eleonora M Vromen
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Sascha Koppes-den Hertog
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Betty M Tijms
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Marta Del Campo
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Barcelonabeta Brain Research Center, Pasqual Maragall Foundation, Barcelona, Spain
- Departamento de Ciencias Farmacéuticas y de la Salud, Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Sanne Abeln
- Computer Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- CWI, Amsterdam , The Netherlands
| | - Charlotte E Teunissen
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lisa Vermunt
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Aguirre A, Hilsabeck RC, O'Mahar K, Carberry KE, Ayers G, Bertelson J, Rousseau JF, Paydarfar D. Designing an interprofessional dementia specialty clinic: Conceptualization and evaluation of a patient-centered model. J Interprof Care 2023; 37:254-261. [PMID: 36739557 DOI: 10.1080/13561820.2022.2060194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The need for blueprints to design specialty care interprofessional collaboration (IPC) models is urgent, given the expanding aging population and current challenges in dementia diagnosis and treatment. We describe key steps creating an interprofessional outpatient dementia specialty clinic, efforts to sustain the model, and evaluation of interprofessional effectiveness and clinician satisfaction. The conception for the Comprehensive Memory Center was informed by qualitative research methodologies including focus groups, interviews, and literature reviews. Quantitative evaluation included satisfaction surveys and team effectiveness measures. The IPC model diverges from typical dementia practices through its interprofessional team, visit structure, approach to decision-making, in-house services, and community collaborations. Team retreats and workshops helped build clinician knowledge of interprofessional values and practices to sustain the IPC model. In the first 3.5 years, we served nearly 750 patients and their caregivers. Team evaluation results revealed that increased access to consultation and sharing the workload and emotional burden were beneficial. The majority of team members preferred the IPC model to traditional models of clinical care.
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Affiliation(s)
- Alyssa Aguirre
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA.,The University of Texas at Austin, Steve Hicks School of Social Work, USA
| | - Robin C Hilsabeck
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA
| | - Kerry O'Mahar
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA.,Psychology-Neuropsychology, Advocate Aurora Health, USA
| | - Kathleen E Carberry
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA.,The University of Texas at Austin, McCombs School of Business, USA
| | - Gayle Ayers
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA.,Psychiatry, Ascension Seton Healthcare, USA
| | | | - Justin F Rousseau
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA
| | - David Paydarfar
- Department of Neurology, The University of Texas at Austin Dell Medical School, USA
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Salim A, Stein DM, Zarzaur BL, Livingston DH. Measuring long-term outcomes after injury: current issues and future directions. Trauma Surg Acute Care Open 2023; 8:e001068. [PMID: 36919026 PMCID: PMC10008475 DOI: 10.1136/tsaco-2022-001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/16/2023] [Indexed: 03/12/2023] Open
Abstract
Maximizing long-term outcomes for patients following injury is the next challenge in the delivery of patient-centered trauma care. The following review outlines three important components in trauma outcomes: (1) data gathering and monitoring, (2) the impact of traumatic brain injury, and (3) trajectories in recovery and identifies knowledge gaps and areas for needed future research.
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Affiliation(s)
- Ali Salim
- Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah M Stein
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ben L Zarzaur
- Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review. Medicina (B Aires) 2022; 58:medicina58121705. [PMID: 36556907 PMCID: PMC9783876 DOI: 10.3390/medicina58121705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Chodosh J, Connor K, Fowler N, Gao S, Perkins A, Grudzen C, Messina F, Mangold M, Smilowitz J, Boustani M, Borson S. Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e36607. [PMID: 36264626 PMCID: PMC9634513 DOI: 10.2196/36607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post-emergency department care. By identifying and directly addressing patients' and informal caregivers' (or care partners') psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms "caregiver" and "care partner" interchangeably. OBJECTIVE We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients (POISED) trial, compared with usual care. We described the research design, intervention, outcome measures, data collection techniques, and analysis plans. METHODS Emergency department patients who were aged ≥75 years and screened positive for cognitive impairment via either the Mini-Cog or the proxy-reported Short Informant Questionnaire on Cognitive Decline in the Elderly, with a planned discharge to home, were recruited to participate with their identified informal (family or friend) caregiver in the 2-site POISED randomized controlled trial at New York University Langone Health and Indiana University. The intervention group received 6 months of care management from the POISED Care Team of registered nurses and specialty-trained paraprofessionals, who perform root cause analyses, administer standardized assessments, provide advice, recommend appropriate referrals, and, when applicable, implement dementia-specific comorbid condition protocols. The control group received care as recommended at emergency department discharge (usual care) and were given information about resources for further cognitive assessment. The primary outcome is repeat emergency department use; secondary outcomes include caregiver activation for patient health care management, caregiver depression, anxiety, and experience of social support as important predisposing and time-varying enabling and need characteristics. Data were collected from questionnaires and patients' electronic health records. RESULTS Recruitment was conducted between March 2018 and May 2021. Study findings will be published in peer-reviewed journals and presented to peer audiences, decision makers, stakeholders, and other interested persons. CONCLUSIONS The POISED intervention is a promising approach to tailoring care management based on root causes for emergency department admission of patients with cognitive impairment with the aim of reducing readmissions. This trial will provide insights for caregivers and emergency department and primary care providers on appropriate, personalized, and proactive treatment plans for older adults with cognitive impairment. The findings will be relevant to audiences concerned with quality of life for individuals with cognitive impairment and their caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT03325608; https://clinicaltrials.gov/ct2/show/NCT03325608. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36607.
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Affiliation(s)
- Joshua Chodosh
- Division of Geriatrics and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Karen Connor
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Nicole Fowler
- Center for Aging Research Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sujuan Gao
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anthony Perkins
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Corita Grudzen
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | | | - Michael Mangold
- Irving Medical Center, Columbia University, New York, NY, United States
| | - Jessica Smilowitz
- Division of Geriatrics and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Malaz Boustani
- Center for Aging Research Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Soo Borson
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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Campbell NL, Pitts C, Corvari C, Kaehr E, Alamer K, Chand P, Nanagas K, Callahan CM, Boustani MA. Deprescribing anticholinergics in primary care older adults: Experience from two models and impact on a continuous measure of exposure. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:1039-1047. [PMID: 36620097 PMCID: PMC9796793 DOI: 10.1002/jac5.1682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/11/2023]
Abstract
Background Deprescribing interventions delivered through the electronic medical record have not significantly reduced the use of high-risk anticholinergics in prior trials. Pharmacists have been identified as ideal practitioners to conduct deprescribing; however, little experience beyond collaborative consult models has been published. Objective To evaluate the impact of two pilot pharmacist-based advanced practice models nested within primary care. Methods Pilot studies of a collaborative clinic-based pharmacist deprescribing intervention and a telephone-based pharmacist deprescribing intervention were conducted. Patients receiving the clinic-based pharmacy model were aged 55 years and older and referred for deprescribing at a specialty clinic. Patients receiving the telephone-based pharmacy model were aged 65 years and older and called by a clinical pharmacist for deprescribing without referral. Deprescribing was defined as a discontinuation or dose reduction reported either in clinical records or through self-reporting. Results The 18 patients receiving clinic-based deprescribing had a mean age of 68 years and 78% were female. Among 24 medications deemed eligible for deprescribing, 23 (96%) were deprescribed. The clinic-based deprescribing model resulted in a 93% reduction in median annualized total standardized dose (TSD), 56% lowered their annualized exposure below a cognitive risk threshold, and 4 (17%) of medications were represcribed within 6 months. The 24 patients receiving telephone-based deprescribing had a mean age of 73 years and 92% were female. Among 24 medications deemed eligible for deprescribing, 12 (50%) were deprescribed. There was no change in the median annualized TSD, the annualized TSD was lowered below a cognitive risk threshold in 46%, and no medications were represcribed within 6 months. Few withdrawal symptoms or adverse events were reported in both groups. Conclusions Pharmacist-based deprescribing successfully reduced exposure to high-risk anticholinergics in primary care older adults, yet further work is needed to understand the impact on clinical outcomes.
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Affiliation(s)
- Noll L. Campbell
- Department of Pharmacy PracticePurdue University College of PharmacyWest LafayetteIndianaUSA
- Indiana University Center for Aging Research, Regenstrief Institute, Inc.IndianapolisIndianaUSA
- Center for Health Innovation and Implementation ScienceIndiana University School of MedicineIndianapolisIndianaUSA
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolisIndianaUSA
| | | | - Claire Corvari
- Department of PharmacyFranciscan HealthIndianapolisIndianaUSA
| | - Ellen Kaehr
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Khalid Alamer
- Department of Pharmacy PracticePurdue University College of PharmacyWest LafayetteIndianaUSA
| | - Parveen Chand
- Ascenscion St. Vincent North RegionEvansvilleIndianaUSA
| | - Kristine Nanagas
- Ascenscion St. Vincent North RegionEvansvilleIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Christopher M. Callahan
- Indiana University Center for Aging Research, Regenstrief Institute, Inc.IndianapolisIndianaUSA
- Center for Health Innovation and Implementation ScienceIndiana University School of MedicineIndianapolisIndianaUSA
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Regenstrief Institute, Inc.IndianapolisIndianaUSA
- Center for Health Innovation and Implementation ScienceIndiana University School of MedicineIndianapolisIndianaUSA
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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12
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Li L, Zhan S, Naasan G, Ornstein KA, Taioli E, Mazumdar M, Jebakumar J, McCardle K, Liu B. Time trends in cancer and dementia related hospital admissions among Medicare fee-for-service population, 2013-2018. J Geriatr Oncol 2022; 13:1058-1061. [PMID: 35514016 DOI: 10.1016/j.jgo.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Georges Naasan
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jebakaran Jebakumar
- Clinical Operations, Mount Sinai Hospital, New York, NY, United States of America
| | - Ken McCardle
- Clinical Operations, Mount Sinai Hospital, New York, NY, United States of America
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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13
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Toles M, Leeman J, Gwyther L, Vu M, Vu T, Hanson LC. Unique Care Needs of People with Dementia and Their Caregivers during Transitions from Skilled Nursing Facilities to Home and Assisted Living: A Qualitative Study. J Am Med Dir Assoc 2022; 23:1486-1491. [PMID: 35926571 PMCID: PMC9801685 DOI: 10.1016/j.jamda.2022.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of the study was to describe unique care needs of people with dementia (PWD) and their caregivers during transitions from skilled nursing facilities (SNF) to home. DESIGN A qualitative study using focus groups, semistructured interviews, and descriptive qualitative analysis. SETTING AND PARTICIPANTS The study was set in one state, in 4 SNFs where staff had experience using a standardized transitional care protocol. The sample included 22 SNF staff, 4 home health nurses, 10 older adults with dementia, and their 10 family caregivers of whom 39 participated in focus groups and/or interviews. METHODS Data collection included 4 focus groups with SNF staff and semistructured interviews with home health nurses, SNF staff, PWD, and their family caregivers. Standardized focus group and interview guides were used to elicit participant perceptions of transitional care. We used the framework analytic approach to qualitative analysis. A steering committee participated in interpretation of findings. RESULTS Participants described 4 unique care needs: (1) PWD and caregivers may not be ready to fully engage in dementia care planning while in the SNF, (2) caregivers are not prepared to manage dementia symptoms at home, (3) SNF staff have difficulty connecting PWD and caregivers to community supports, and (4) caregivers receive little support to address their own needs. CONCLUSIONS AND IMPLICATIONS Based on findings, recommendations are offered for adapting transitional care to address the needs of PWD and their caregivers. Further research is needed (1) to confirm these findings in larger, more diverse samples and (2) to adapt and test interventions to support successful community discharge of PWD and their caregivers.
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Affiliation(s)
- Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA
| | - Lisa Gwyther
- Duke University, School of Medicine, Durham, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC, USA
| | - Thi Vu
- Yale University, School of Public Health, New Haven, CT, USA
| | - Laura C Hanson
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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14
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Mora Pinzon M, Krainer J, LeCaire T, Houston S, Green‐Harris G, Norris N, Barnes S, Clark LR, Gleason CE, Hermann BP, Ramon H, Buckingham W, Chin NA, Asthana S, Johnson SC, Walaszek A, Carlsson CM. The Wisconsin Alzheimer's Institute Dementia Diagnostic Clinic Network: A community of practice to improve dementia care. J Am Geriatr Soc 2022; 70:2121-2133. [PMID: 35362093 PMCID: PMC9542133 DOI: 10.1111/jgs.17768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/05/2022] [Accepted: 03/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Wisconsin Alzheimer's Institute (WAI) Dementia Diagnostic Clinic Network is a community of practice formed in 1998 as a collaboration of community-based clinics from various healthcare systems throughout the state. Its purpose is to promote the use of evidence-based strategies to provide high quality care throughout Wisconsin for people with dementia. The purpose of this study is to describe the use of a community of practice to facilitate education of healthcare providers on best practices in dementia care, and the implementation of an interprofessional approach to diagnose and manage dementia and related disorders. METHODS Cross-sectional study of the members of the WAI's Dementia Diagnosis Clinic Network. Characteristics of clinics and healthcare teams, learners' participation in educational events and educational outcomes were collected from evaluation forms. Number and characteristics of patients seen in the memory clinics were collected from de-identified data forms submitted by members to a centralized location for data analysis. RESULTS The clinic network currently has 38 clinics affiliated with 26 different healthcare systems or independent medical groups in 21 of 72 Wisconsin counties. Most (56%) are based in primary care, 15% in psychiatry, and 29% in neurology. Between 2018 and 2021, we received data on 4710 patients; 92% were ≥65 years old, 60% were female, and 92% were white. Network members meet in-person twice a year to learn about innovations in the field of dementia care and to share best practices. Educational events associated with the network are shown to be relevant, useful, and improve knowledge and skills of participants. CONCLUSION Communities of practice provide added value via shared best practices and educational resources, continuing education of the health workforce, continuous quality improvement of clinical practices, and adoption of new diagnostic and management approaches in dementia care.
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Affiliation(s)
- Maria Mora Pinzon
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Family Medicine and Community HealthUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jody Krainer
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Tamara LeCaire
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Stephanie Houston
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Gina Green‐Harris
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Nia Norris
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Stacy Barnes
- College of NursingMarquette UniversityMilwaukeeWisconsinUSA
| | - Lindsay R. Clark
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Carey E. Gleason
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Bruce P. Hermann
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Will Buckingham
- Center for Health Disparities Research (CHDR), School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sanjay Asthana
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Art Walaszek
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
- Department of PsychiatryUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin, School of Medicine and Public HealthMadisonWisconsinUSA
- Department of Medicine, Division of Geriatrics and GerontologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- VA Geriatric Research, Education and Clinical Center (GRECC)William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
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15
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Schiller C, Grünzig M, Heinrich S, Meyer G, Bieber A. Case management for people with dementia living at home and their informal caregivers: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1233-1253. [PMID: 34783085 DOI: 10.1111/hsc.13647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Case management is a complex intervention aimed at addressing a variety of health needs of people in their social environment. Case management for people with dementia is often poorly defined and insufficiently described. The crucial process steps are often not well understood. We aim to map and compare the key components, processes and contextual factors of case management programmes for dementia and to explore aspects of the interventions' generalisability. Our search covered the databases PubMed, CINAHL, Cochrane and GeroLit, as well as policy papers from international organisations. We included qualitative, quantitative and mixed-methods studies in the English or German language that was published between 1999 and 2020. The programmes were analysed according to programme characteristics, case management intervention and the structural and processing conditions. We identified 67 studies dealing with 25 programmes. Approximately half of the programmes were investigated in randomised controlled trials, two programmes used a mixed-methods design and the remaining were the subject of pre-post cohort studies. Participants in the studies were predominantly dyads of people with dementia and their informal caregivers. About half of the programmes reported a theoretical framework. All the programmes were derived from case management approaches or referred to such approaches. Despite huge differences in implementation, all the programmes covered the case management steps. In 14 out of 25 programmes, case management was carried out without additional intervention, the other programmes provided mainly education and training for informal caregivers. Costs of the case management interventions were stated in more than half of the programmes.The effectiveness and generalisability of dementia-specific case management interventions could be enhanced if the framework introduced in the review was used in the future by policy, practice and research.
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Affiliation(s)
- Christine Schiller
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Manuela Grünzig
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephanie Heinrich
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gabriele Meyer
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anja Bieber
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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16
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Sawan MJ, Gench M, Bond C, Jeon YH, Hilmer SN, Chen TF, Gnjidic D. Development of a tool to evaluate medication management guidance provided to carers of people living with dementia at hospital discharge: a mixed methods study. BMJ Open 2022; 12:e058237. [PMID: 35501104 PMCID: PMC9062821 DOI: 10.1136/bmjopen-2021-058237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Medication management guidance for carers of people with dementia at hospital discharge is important to prevent medication-related harm during transitions of care. This study aimed to develop a tool to evaluate medication management guidance provided to carers of people with dementia at hospital discharge. DESIGN The tool was developed using mixed methods involving two stages. Stage 1 involved item generation and content validation. Items were based on a previous qualitative study and systematic review. Content validation involved experts and consumers with knowledge or experience of medication management guidance in the acute care setting, and rating each item on importance and relevance. Stage 2 involved conducting cognitive interviews with carers of people with dementia to pretest the tool. SETTING For stage 1, experts and consumers from Australia, USA and New Zealand were included. For stage 2, carers of people with dementia were recruited across Australia. PARTICIPANTS 18 experts and consumers participated in round 1 of content validation, and 13 experts and consumers completed round 2. Five carers of people with dementia participated in cognitive interviews. RESULTS The final tool contained 30 items capturing information across five domains: (1) provision of medication management guidance at hospital discharge; (2) carer understanding of medication management guidance provided at discharge; (3) carer engagement in discussing the safe use of medications at discharge; (4) carer preparedness to conduct medication management activities after discharge; and (5) co-ordination of medication management guidance after discharge. CONCLUSIONS We developed the first tool to assess medication management guidance provided for carers of people with dementia at hospital discharge. The tool may be useful to inform future research strategies to improve the delivery of medication management guidance at discharge.
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Affiliation(s)
- Mouna J Sawan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Gench
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Royal North Shore Hospital and the University of Sydney, St Leonards, New South Wales, Australia
| | - Timothy F Chen
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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17
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Kovaleva MA, Higgins M, Dietrich MS, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn K. Characteristics associated with neuropsychiatric symptoms in persons living with dementia and caregiver distress and diminished well-being. J Am Assoc Nurse Pract 2022; 34:656-665. [PMID: 35025838 DOI: 10.1097/jxx.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The population of persons living with dementia (PLWDs) is increasing, although mainstream dementia care quality is suboptimal. PURPOSE To identify characteristics associated with: (1) PLWDs' neuropsychiatric symptoms and quality of life; and (2) distress from neuropsychiatric symptoms and well-being among their family caregivers (N = 49). METHODOLOGY Cross-sectional single-group examination of PLWD and caregivers when they enrolled into a nurse-led dementia-centered primary care clinic. Pearson correlations were run between characteristics of PLWD and caregiver and variables representing PLWD's neuropsychiatric symptoms and quality of life and their caregivers' well-being. Statistically significant correlations were reported via Cohen d statistics. RESULTS Caregivers' characteristics associated with higher distress from neuropsychiatric symptoms and diminished well-being included Black race, female gender, younger age, caring for a parent with dementia, and being employed. Characteristics of PLWD associated with caregivers' higher distress and diminished well-being included longer time since dementia onset, higher Charlson Comorbidity Index, and non-Alzheimer dementia. Caregivers' characteristics associated with higher neuropsychiatric symptom burden included Black race, female gender, younger age, caring for parent PLWD, and being employed. Characteristics of PLWDs associated with higher neuropsychiatric symptom burden included non-Alzheimer dementia, longer time since dementia onset, more comorbidities, and higher Charlson Comorbidity Index. Finally, a longer time since dementia onset was associated with PLWDs' lower quality of life. CONCLUSIONS Black race, caring for caring for a parent with dementia, younger age, and being employed were characteristics linked to PLWDs' higher neuropsychiatric symptom burden and caregivers' diminished well-being. IMPLICATIONS Clinicians must assess and intervene with unpaid caregivers who may not appear obviously distressed.
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Affiliation(s)
- Mariya A Kovaleva
- University of Nebraska Medical Center College of Nursing, Omaha, Nebraska
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Integrated Memory Care Clinic, Emory Healthcare, Atlanta, Georgia
| | - Patricia C Griffiths
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Assistive Technology and Environmental Access, Georgia Institute of Technology, Atlanta, Georgia
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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18
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Boyd ND, Naasan G, Harrison KL, Garrett SB, D’Aguiar Rosa T, Pérez-Cerpa B, McFarlane S, Miller BL, Ritchie CS. Characteristics of people with dementia lost to follow-up from a dementia care center. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5628. [PMID: 34590336 PMCID: PMC8740544 DOI: 10.1002/gps.5628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status. METHODS We conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n = 746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status. Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU. RESULTS Among PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to follow-up. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p = 0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p = 0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p = 0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%). CONCLUSIONS PLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care.
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Affiliation(s)
- Nicole D. Boyd
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Georges Naasan
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Department of Neurology, Mount Sinai Hospitals, Ichan School of Medicine, New York City, New York, USA
| | - Krista L. Harrison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA,University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Sarah B. Garrett
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Talita D’Aguiar Rosa
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Brenda Pérez-Cerpa
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Hospital Civil de Guadalajara (Hospital Civil Fray Antonio Alcade), Guadalajara, Jalisco, Mexico
| | - Shamiel McFarlane
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA
| | - Bruce L. Miller
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA,University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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19
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Callahan KE. Challenges and Facilitators in Implementing a Focus on Function in Structured Clinical Settings. THE PUBLIC POLICY AND AGING REPORT 2021; 32:13-18. [PMID: 35127104 PMCID: PMC8803265 DOI: 10.1093/ppar/prab028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Kathryn E Callahan
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA,Address correspondence to: Kathryn E. Callahan, MD, MS, Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 USA. E-mail:
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20
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Sawan MJ, Jeon YH, Bond C, Hilmer SN, Chen TF, Wennekers D, Gnjidic D. Caregivers' experiences of medication management advice for people living with dementia at discharge. J Eval Clin Pract 2021; 27:1252-1261. [PMID: 33586327 DOI: 10.1111/jep.13551] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Caregivers of people living with dementia play an essential role in managing medications across transitions of care. Adequate caregiver medication management guidance at hospital discharge is important to ensure optimal outcomes from medication use. This qualitative study explores the experiences and perspectives of caregivers about the medication management guidance provided at hospital discharge. METHODS A qualitative approach using semi-structured, telephone interviews was conducted with 31 caregivers of people with dementia across Australia. Purposive sampling was used to ensure maximum variation of diverse experiences and perspectives. RESULTS Caregivers' experiences of medication guidance for people with dementia at discharge were described in three themes including: (a) inadequate information about medication management at discharge; (b) limited caregiver engagement in medication management decisions; and (c) difficulties ensuring medication supply post discharge. Most participants indicated they would like to be included in discussions at discharge. However, participation was influenced by caregivers being overwhelmed by discharge processes; proactively seeking information on medication-related harm; and belief in advocacy as part of their caregiver role. Caregivers reported they would like to receive a tailored medication list for people with dementia which included information on medications that may impact on the patient's cognition, and for hospital staff to communicate with both the community pharmacist and primary care physician, to improve co-ordination post transition. DISCUSSION In our study of caregivers of people with dementia, we identified key recommendations to facilitate regular participation of people living with dementia and their caregiver around medication guidance at discharge.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun-Hee Jeon
- Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christine Bond
- School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Sarah N Hilmer
- Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Faculty of Medicine and Health, Royal North Shore Hospital and Northern Clinical School, St Leonards, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
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21
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Leon T, Castro L, Mascayano F, Lawlor B, Slachevsky A. Evaluating a Memory Clinic Using the RE-AIM Model. The Experience of the "Memory and Neuropsychiatry Clinic" in Hospital Del Salvador, Chile. Front Neurol 2021; 12:612416. [PMID: 34552545 PMCID: PMC8451412 DOI: 10.3389/fneur.2021.612416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/30/2021] [Indexed: 12/25/2022] Open
Abstract
The development of healthcare services for dementia is key to improving access to care and post-diagnostic support for people living with dementia. Memory Units have emerged as a new healthcare service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The main objective of this study was to describe and evaluate the Reach and Effectiveness of a Memory Unit in a public hospital in Chile, using the RE-AIM model, a multi-component model that allows for the evaluation of the implementation of ongoing healthcare programs. Regarding “R” (Reach): from March 2018 up to June 2019, a total of 510 patients were referred and assessed. Most patients came from primary care (51.9%) and from outpatient services at the Hospital Salvador (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that our Memory Unit assessed 5.39% of all of the dementia patients living in the area of referral. With respect to “E” (Effectiveness): 419 patients are still being followed up at the Memory Unit. Ninety-one patients (18%) were discharged. Of these, 55 (66%) were referred to primary healthcare, 28 (31%) to other outpatient services, 9 (10%) to a specialized mental healthcare center, and 9 (10%) to a daycare center. Due to the short period of time that the Memory Unit has been operating, no other RE-AIM dimensions could be evaluated at this juncture. To our knowledge, this is the first implementation study of a Memory Unit in Latin America, and the first using the RE-AIM model. Although cultural differences worldwide might play a role in the lack of international guidelines, the publication of the experience of the first year of this unit in Chile could inform new countries about this process. Ongoing challenges include continuing to collect data to complement the RE-AIM evaluation and developing a protocol that can be adopted elsewhere in Chile and Latin America. Further studies are needed to assess the benefits of a Memory Unit in comparison to regular care and to develop a model that assures continuity and coordination of care for people with dementia.
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Affiliation(s)
- Tomas Leon
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Department of Psychiatry and Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Loreto Castro
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile
| | - Franco Mascayano
- Mailman School of Public Health, Columbia University, New York, NY, United States.,Department of Psychiatry, New York State Psychiatric Institute, New York, NY, United States
| | - Brian Lawlor
- Department of Psychiatry and Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic, Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile.,Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, Instituto de Ciencias Biomedicas (ICBM), Neurosciences and East Campus Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.,Neurology Unit, Department of Medicine, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
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22
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Sawan MJ, Wennekers D, Sakiris M, Gnjidic D. Interventions at Hospital Discharge to Guide Caregivers in Medication Management for People Living with Dementia: a Systematic Review. J Gen Intern Med 2021; 36:1371-1379. [PMID: 33537953 PMCID: PMC8131426 DOI: 10.1007/s11606-020-06442-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hospital discharge has a significant impact on the continuity of care for people living with dementia. Clear guidance on medication management should be provided to caregivers of people living with dementia to ensure appropriate use of medications post-discharge. AIM Identify and appraise the impact of interventions at hospital discharge to guide caregivers in the medication management for people living with dementia. METHOD A systematic search of original studies was performed in Medline, Embase, PsycINFO, and CINAHL. Articles published in English that reported on interventions to guide caregivers in medication management for people living with dementia were included. Two authors independently reviewed titles and abstract. Full-text articles were assessed for eligibility and quality assessment was conducted by two authors. RESULTS A total of five studies were included with a range of interventions that were typically delivered post-discharge by a multidisciplinary team and most targeted administration of medications by caregivers. Overall, three types of discharge interventions were identified including a pre-discharge caregiver educational intervention, a post-discharge multidisciplinary team intervention, and discharge summary documentation intervention at transitions of care. Of these, a pre-discharge caregiver education led to shorter hospital stay (25 days vs. 31 days, p = 0.005). A post-discharge intervention that included follow-up visits resulted in lower use of high-risk medications (19% vs. 40%), and reduction in 30-day re-hospitalization rates (11% vs. 20%). In contrast, in another post-discharge intervention study, no difference in one-month re-hospitalization rates (8.4% vs. 8.0%, p = 0.82) was demonstrated. In another study, a post-discharge hospital educational program provided to caregivers led to significantly reduced caregiver burden (31.7 ± 17.6 (SD) pre-intervention to 27.7 ± 16.9 (SD) post-intervention (p = 0.037)). DISCUSSION Current findings suggest there is a need for well-designed interventions to guide caregivers in all aspects of medication management for people living with dementia, and should include support for caregivers in care coordination.
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Affiliation(s)
- Mouna J Sawan
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Damian Wennekers
- School of Pharmacy, Faculty of Science, University of Utrecht, Utrecht, The Netherlands
| | - Marissa Sakiris
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
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23
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Campbell NL, Holden RJ, Tang Q, Boustani MA, Teal E, Hillstrom J, Tu W, Clark DO, Callahan CM. Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults. J Am Geriatr Soc 2021; 69:1490-1499. [PMID: 33772749 DOI: 10.1111/jgs.17121] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/10/2021] [Accepted: 02/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To test the impact of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults. DESIGN Cluster-randomized controlled trial. SETTING AND PARTICIPANTS Ten primary care clinics within Eskenazi Health in Indianapolis. INTERVENTION The multicomponent intervention included provider- and patient-focused components. The provider-focused component was computerized decision support alerting of the presence of a high-risk anticholinergic and offering dose- and indication-specific alternatives. The patient-focused component was a story-based video providing education and modeling an interaction with a healthcare provider resulting in a medication change. Alerts within the medical record triggered staff to play the video for a patient. Our design intended for parallel, independent priming of both providers and patients immediately before an outpatient face-to-face interaction. MEASUREMENT Medication orders were extracted from the electronic medical record system to evaluate the prescribing behavior and population prevalence of anticholinergic users. The intervention was introduced April 1, 2019, through March 31, 2020, and a preintervention observational period of April 1, 2018, through March 31, 2019, facilitated difference in difference comparisons. RESULTS A total of 552 older adults had visits at primary care sites during the study period, with mean age of 72.1 (SD 6.4) years and 45.3% African American. Of the 259 provider-focused alerts, only three (1.2%) led to a medication change. Of the 276 staff alerts, 4.7% were confirmed to activate the patient-focused intervention. The intervention resulted in no significant differences in either the number of discontinue orders for anticholinergics (intervention: two additional orders; control: five fewer orders, p = 0.7334) or proportion of the population using anticholinergics following the intervention (preintervention: 6.2% and postintervention: 5.1%, p = 0.6326). CONCLUSION This multicomponent intervention did not reduce the use of high-risk anticholinergics in older adults receiving primary care. Improving nudges or a policy-focused component may be necessary to reduce use of high-risk medications.
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Affiliation(s)
- Noll L Campbell
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA.,Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richard J Holden
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Qing Tang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Malaz A Boustani
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Evgenia Teal
- Data Core, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jennifer Hillstrom
- Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel O Clark
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher M Callahan
- Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.,Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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24
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Fowler NR, Judge KS, Lucas K, Gowan T, Stutz P, Shan M, Wilhelm L, Parry T, Johns SA. Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer's disease and related dementias. BMC Geriatr 2021; 21:127. [PMID: 33593296 PMCID: PMC7885205 DOI: 10.1186/s12877-021-02078-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background Caregivers of patients with Alzheimer’s disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. Methods ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor’s-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire–9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). Results All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as “completely satisfied.” At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. Conclusions Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach. Trial registration Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.
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Affiliation(s)
- Nicole R Fowler
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA. .,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA.
| | - Katherine S Judge
- Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Kaitlyn Lucas
- Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, 44115, USA
| | - Tayler Gowan
- Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA
| | - Patrick Stutz
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA
| | - Mu Shan
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Department of Biostatistics, School of Medicine, Indiana University, 410 W. 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Laura Wilhelm
- Department of Behavioral Medicine and Psychiatry, West Virginia University, 3200 MacCorkle Ave., SE, Charleston, WV, 25304, USA
| | - Tommy Parry
- Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 N Blackford St, Indianapolis, IN, 46202, USA
| | - Shelley A Johns
- Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 N Blackford St, Indianapolis, IN, 46202, USA.,IUPUI Research in Palliative and End-of-Life Communication and Training Center, Indiana University-Purdue University Indianapolis, Indianapolis, USA
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25
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Kovaleva MA, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn K. Caregivers' Experience at an Integrated Memory Care Clinic. Res Gerontol Nurs 2021; 14:69-78. [PMID: 33492401 DOI: 10.3928/19404921-20210115-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Integrated Memory Care Clinic is a patient-centered medical home led by advanced practice RNs (APRNs) who provide dementia care and primary care simultaneously and continuously. We explored the experiences of 12 informal caregivers of persons living with dementia during their first year at the Clinic. Data were analyzed via directed content analysis. Caregivers described the Clinic as "the only place you should go to for dementia [care]." Caregivers felt a sense of belonging to the Clinic, valued APRNs' competence and staff's dedication, and round-the-clock telephone access to APRNs. Caregivers also acknowledged that "we're all out here swimming on our own." They expressed their sense of being overwhelmed and needing more services and medical and non-medical resources, and more prognostic information on dementia. Although the Clinic is beneficial for caregivers, caregiving demands exceed the supply of services and resources at the Clinic. [Research in Gerontological Nursing, 14(2), 69-78.].
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Anderson TS, Marcantonio ER, McCarthy EP, Herzig SJ. National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia. J Am Geriatr Soc 2020; 68:2240-2248. [PMID: 32700399 DOI: 10.1111/jgs.16636] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/OBJECTIVES Dementia is associated with higher healthcare expenditures, in large part due to increased hospitalization rates relative to patients without dementia. Data on contemporary trends in the incidence and outcomes of potentially preventable hospitalizations of patients with dementia are lacking. DESIGN Retrospective cohort study using the National Inpatient Sample from 2012 to 2016. SETTING U.S. acute care hospitals. PARTICIPANTS A total of 1,843,632 unique hospitalizations of older adults (aged ≥65 years) with diagnosed dementia. MEASUREMENTS Annual trends in the incidence of hospitalizations for all causes and for potentially preventable conditions including acute ambulatory care sensitive conditions (ACSCs), chronic ACSCs, and injuries. In-hospital outcomes including mortality, discharge disposition, and hospital costs. RESULTS The survey weighted sample represented an estimated 9.27 million hospitalizations for patients with diagnosed dementia (mean [standard deviation] age = 82.6 [6.7] years; 61.4% female). In total, 3.72 million hospitalizations were for potentially preventable conditions (40.1%), 2.07 million for acute ACSCs, .76 million for chronic ACSCs, and .89 million for injuries. Between 2012 and 2016, the incidence of all-cause hospitalizations declined from 1.87 million to 1.85 million per year (P = .04) while the incidence of potentially preventable hospitalizations increased from .75 million to .87 million per year (P < .001), driven by an increased number of hospitalizations of community-dwelling older adults. Among patients with dementia hospitalized for potentially preventable conditions, inpatient mortality declined from 6.4% to 6.1% (P < .001), inflation-adjusted median costs increased from $7,319 to $7,543 (P < .001), and total annual costs increased from $7.4 to $9.3 billion. Although 86.0% of hospitalized patients were admitted from the community, only 32.7% were discharged to the community. CONCLUSION The number of potentially preventable hospitalizations of older adults with dementia is increasing, driven by hospitalizations of community-dwelling older adults. Improved strategies for early detection and goal-directed treatment of potentially preventable conditions in patients with dementia are urgently needed. J Am Geriatr Soc 68:2240-2248, 2020.
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Affiliation(s)
- Timothy S Anderson
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Edward R Marcantonio
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Ellen P McCarthy
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Shoshana J Herzig
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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27
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Jennings LA, Hollands S, Keeler E, Wenger NS, Reuben DB. The Effects of Dementia Care
Co‐Management
on Acute Care, Hospice, and Long‐Term Care Utilization. J Am Geriatr Soc 2020; 68:2500-2507. [DOI: 10.1111/jgs.16667] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Lee A. Jennings
- Reynolds Section of Geriatrics, Department of Medicine University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
| | | | | | - Neil S. Wenger
- Division of General Internal Medicine and Health Services Research David Geffen School of Medicine, University of California Los Angeles California USA
| | - David B. Reuben
- Multicampus Program in Geriatric Medicine and Gerontology David Geffen School of Medicine, University of California Los Angeles California USA
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28
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Kovaleva MA, Higgins M, Jennings BM, Song MK, Clevenger CK, Griffiths PC, Hepburn K. Patient and caregiver outcomes at the integrated memory care clinic. Geriatr Nurs 2020; 41:761-768. [PMID: 32513481 DOI: 10.1016/j.gerinurse.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC). IMCC advanced practice registered nurses provide dementia care and primary care simultaneously and continuously to PLWD until institutionalization. Changes were examined in caregivers' psychological well-being (perceived stress, depressive symptoms, caregiver burden, and anxiety) and health status and in PLWDs' quality of life and neuropsychiatric symptoms. Data were collected at baseline, then 3 and 6 months post-baseline. Forty-two caregivers completed all 3 assessments. Most variables remained unchanged. Statistically significant improvements in 5 sub-scales of the Neuropsychiatric Inventory were observed: caregivers' distress regarding their PLWDs' delusions and anxiety, and PLWDs' severity of delusions, depression, and total symptom severity. Further testing of the IMCC is required, including in quasi-experimental studies, to determine its efficacy.
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Affiliation(s)
- Mariya A Kovaleva
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | | | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States.
| | - Carolyn K Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States; Integrated Memory Care Clinic, Emory Healthcare, Atlanta, GA 30329, United States; Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA 30329, United States.
| | - Patricia C Griffiths
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States; Birmingham/Atlanta Geriatric Research Education and Clinical Center, Decatur, GA 3033, United States.
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, United States; Emory University Goizueta Alzheimer's Disease Research Center, Atlanta, GA 30329, United States; Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States.
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29
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Carnahan JL, Judge KS, Daggy JK, Slaven JE, Coleman N, Fortier EL, Suelzer C, Fowler NR. Supporting caregivers of veterans with Alzheimer's disease and traumatic brain injury: study protocol for a randomized controlled trial. Trials 2020; 21:340. [PMID: 32306982 PMCID: PMC7168967 DOI: 10.1186/s13063-020-4199-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with Alzheimer’s disease and related dementias (ADRD) and traumatic brain injury (TBI) and their caregivers require cognitive and behavioral symptom management, interdisciplinary care, support for caregivers, and seamless care coordination between providers. Caring for someone with ADRD or TBI is associated with higher rates of psychological morbidity and burden, social isolation, financial hardship, and deterioration of physical health. Tremendous need exists for primary care–based interventions that concurrently address the care needs of dyads and aim to improve care and outcomes for both individuals with ADRD and TBI and their family caregivers. Methods The Aging Brain Care Acquiring New Skills While Enhancing Remaining Strengths (ABC ANSWERS) study is a randomized controlled trial that tests the effectiveness of an intervention based on two evidence-based programs that have been developed for and previously tested in populations with ADRD, TBI, stroke, and late-life depression and/or who have survived an intensive care unit stay. This study includes 200 dyads comprised of a veteran with a diagnosis of ADRD or TBI and the veteran’s primary informal caregiver. Dyads are randomized to receive the ABC ANSWERS intervention or routine Veterans Health Administration (VHA) primary care with a standardized educational and resource information packet. Data collection occurs at baseline and three follow-up time points (3 months, 6 months, and 12 months). The primary outcome is caregiver quality of life (QoL). A secondary measure for the caregiver is caregiver burden. Secondary measures for both the veteran and caregiver include symptoms of depression and anxiety. Discussion The ABC ANSWERS intervention integrates common features of an evidence-based collaborative care model for brain health while concurrently attending to the implementation barriers of delivering care and skills to dyads. We hypothesize that caregivers in dyads randomized to the ABC ANSWERS program will experience higher levels of QoL and lower levels of depression, anxiety, dyadic strain, and caregiver burden at 12 months than those receiving usual VHA primary care. Trial registration ClinicalTrials.gov, NCT03397667. Registered on 12 January 2018.
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Affiliation(s)
- Jennifer L Carnahan
- Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN, 46202, USA.,Division of General Internal Medicine and Geriatrics, Indianapolis, USA.,Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, USA
| | - Katherine S Judge
- Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, USA
| | - Joanne K Daggy
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, Suite 3000, Indianapolis, IN, 46202, USA
| | - Nicki Coleman
- Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, USA
| | - Emily L Fortier
- Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, USA
| | - Christopher Suelzer
- Richard L. Roudebush VA Medical Center Research Services, 1481 West 10th Street, Indianapolis, IN, 46202, USA
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN, 46202, USA. .,Division of General Internal Medicine and Geriatrics, Indianapolis, USA. .,Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, USA.
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Iliffe S, Gallo JJ. Perspectives From the Primary Care Setting on Managing Dementia: Commentary on Heintz et al. American Journal of Geriatric Psychiatry. Am J Geriatr Psychiatry 2020; 28:334-336. [PMID: 31606275 DOI: 10.1016/j.jagp.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health (SI), University College London, United Kingdom
| | - Joseph J Gallo
- Department of Mental Health (JJG), Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
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Heintz H, Monette P, Epstein-Lubow G, Smith L, Rowlett S, Forester BP. Emerging Collaborative Care Models for Dementia Care in the Primary Care Setting: A Narrative Review. Am J Geriatr Psychiatry 2020; 28:320-330. [PMID: 31466897 DOI: 10.1016/j.jagp.2019.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023]
Abstract
The rapidly increasing population living with dementia presents a unique economic and public health challenge. However, primary care physicians, despite their position as first-line providers, often lack the time, support, and training to systematically screen for, diagnose, and treat dementia, as well as provide adequate psychosocial support to unpaid caregivers. Models of collaborative care, which have found success in reducing symptom severity and increasing quality of life for other chronic illnesses, have been studied for feasibility, efficacy, and cost effectiveness in treating individuals with dementia and supporting caregivers. A review of initial data from several models suggests that enrollment in a collaborative care program for dementia is associated with benefits such as reduction in behavioral symptoms of dementia, improved functioning and quality of life, less frequent utilization of acute medical services, and decrease in caregiver burden. These evidence-based models, if implemented widely, stand to facilitate delivery of highly effective dementia care while reducing associated total medical expense. In this narrative review, we examine the key components of collaborative care teams, summarize outcomes of prior studies and discuss barriers and opportunities for wider dissemination of collaborative care models that are partnered with and/or based within primary care settings.
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Affiliation(s)
- Hannah Heintz
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA
| | - Patrick Monette
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA
| | - Gary Epstein-Lubow
- Hebrew SeniorLife (GE-L), Roslindale, MA; Department of Psychiatry, Harvard Medical School (GE-L, BPF), Boston, MA
| | - Lorie Smith
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital (LS, SR), Boston, MA
| | - Susan Rowlett
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital (LS, SR), Boston, MA
| | - Brent P Forester
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA; Department of Psychiatry, Harvard Medical School (GE-L, BPF), Boston, MA; Partners Population Health, Partners Healthcare (BPF), Somerville, MA.
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Fowler NR, Head KJ, Perkins AJ, Gao S, Callahan CM, Bakas T, Suarez SD, Boustani MA. Examining the benefits and harms of Alzheimer's disease screening for family members of older adults: study protocol for a randomized controlled trial. Trials 2020; 21:202. [PMID: 32075686 PMCID: PMC7031904 DOI: 10.1186/s13063-019-4029-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple national expert panels have identified early detection of Alzheimer's disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. METHODS The Caregiver Outcomes of Alzheimer's Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1800 dyads who will be randomized into three groups (n = 600/group): the 'Screening Only' group will receive ADRD screening at baseline and disclosure of the screening results, with positive-screen participants receiving a list of local resources for diagnostic follow-up; the 'Screening Plus' group will receive ADRD screening at baseline coupled with disclosure of the screening results, with positive-screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and the control group will receive no screening. The COADS trial will measure the quality of life of the family member (the primary outcome) and family member mood, anxiety, preparedness and self-efficacy (the secondary outcomes) at baseline and at 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). DISCUSSION We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer's Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03300180. Registered on 3 October.
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Affiliation(s)
- Nicole R. Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
| | - Katharine J. Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202 USA
| | - Anthony J. Perkins
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202 USA
| | - Christopher M. Callahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Eskenazi Health, Indianapolis, IN 46202 USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH 45219 USA
| | - Shelley D. Suarez
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
| | - Malaz A. Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202 USA
- Indiana University Center for Aging Research, Indianapolis, IN 46202 USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202 USA
- Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN 46202 USA
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Lord K, Beresford-Dent J, Rapaport P, Burton A, Leverton M, Walters K, Lang I, Downs M, Manthorpe J, Boex S, Jackson J, Ogden M, Cooper C. Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1-14. [PMID: 31679047 DOI: 10.1007/s00127-019-01784-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. METHODS We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. RESULTS Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. CONCLUSIONS Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. TRIAL REGISTRATION PROSPERO 2018 registration number: CRD42018099693 (scoping review). PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).
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Affiliation(s)
- Kathryn Lord
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Jules Beresford-Dent
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Alex Burton
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Iain Lang
- South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Murna Downs
- Faculty of Health Studies, Centre for Applied Dementia Studies, Horton A Building, Richmond Road, Bradford, BD7 1DP, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, WC2R 2LS, UK
| | - Sue Boex
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Joy Jackson
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Margaret Ogden
- Alzheimer's Society Research Network Volunteer, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, 6th Floor Maple House, Tottenham Court Road, London, W1T 7NF, UK.
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Holden RJ, Campbell NL, Abebe E, Clark DO, Ferguson D, Bodke K, Boustani MA, Callahan CM. Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults. Res Social Adm Pharm 2020; 16:54-61. [PMID: 30853507 PMCID: PMC6710164 DOI: 10.1016/j.sapharm.2019.02.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. OBJECTIVE This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. METHODS Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. RESULTS Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to "Good" to "Excellent" usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. CONCLUSION Consumer-facing technology can be a low-cost, scalable intervention to improve older adults' medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change.
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Affiliation(s)
- Richard J Holden
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine and Regenstrief Institute, Inc., Indianapolis, IN, USA.
| | - Noll L Campbell
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine and Regenstrief Institute, Inc., Indianapolis, IN, USA; Purdue University College of Pharmacy, West Lafayette, IN, USA; Eskenazi Health, Indianapolis, IN, USA
| | - Ephrem Abebe
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University-School of Medicine, Baltimore, MD, USA
| | - Daniel O Clark
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Denisha Ferguson
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Kunal Bodke
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Innovation and Implementation Science, Indiana University School of Medicine and Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
| | - Christopher M Callahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, IN, USA
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Fowler NR, Perkins AJ, Gao S, Sachs GA, Boustani MA. Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial. J Am Geriatr Soc 2019; 68:535-543. [PMID: 31792940 DOI: 10.1111/jgs.16247] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/30/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = -0.063 to 0.080]; P = .81). At 1 month, differences in mean depressive symptoms (mean difference = -0.23 [90% CI = -0.42 to -0.039]) and anxiety symptoms (mean difference = -0.087 [90% CI = -0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings. J Am Geriatr Soc 68:535-543, 2020.
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Affiliation(s)
- Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Greg A Sachs
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, Indiana
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Geriatric models of care for neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2019. [PMID: 31753156 DOI: 10.1016/b978-0-12-804766-8.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
New models of care seek to reorganize healthcare to meet the challenges of a growing number of persons with chronic conditions, to optimize the use of the available workforce, and to improve the quality of care. Increasingly, these models also seek to organize care in a manner that addresses cost and efficiency in addition to quality of care. This chapter first revisits the history of chronic care models and then provides a description of successful and sustainable examples of integrated, multidisciplinary approaches for persons with dementia, persons with Parkinson's disease, and the frail elderly. We focus on models for neurodegenerative diseases and draw from the perspectives of research, clinical practice, and informal caregiving. Although focused on neurodegenerative disease, the principles of these approaches reflect the hallmarks of good primary, geriatric, and collaborative care. Many of the current models of care emanate from a medical approach led by physicians and other professional providers within the formal healthcare setting. Innovative approaches, however, now seek to incorporate these medical models within social and community services. We conclude this chapter by describing several international examples of community-based efforts that have been implemented to improve the care and lives of patients with dementia and their informal caregivers, which is at present one of the top priorities in many countries.
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Morgan D, Kosteniuk J, O’Connell ME, Kirk A, Stewart NJ, Seitz D, Bayly M, Froehlich Chow A, Elliot V, Daku J, Hack T, Hoium F, Kennett-Russill D, Sauter K. Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation. BMC Health Serv Res 2019; 19:709. [PMID: 31623609 PMCID: PMC6798332 DOI: 10.1186/s12913-019-4548-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. METHODS A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. RESULTS Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. CONCLUSIONS The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.
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Affiliation(s)
- Debra Morgan
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Julie Kosteniuk
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Megan E. O’Connell
- Department of Psychology, University of Saskatchewan, Arts 182, 9 Campus Drive, Saskatoon, SK S7N 5A5 Canada
| | - Andrew Kirk
- Department of Medicine, Neurology Division, University of Saskatchewan, Saskatoon, SK Canada
| | - Norma J. Stewart
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK Canada
| | - Dallas Seitz
- Department of Psychiatry, Providence Care - Mental Health Services, Queen’s University, 752 King Street West, Kingston, ON K7L 4X3 Canada
- Cumming School of Medicine and Hotchkiss Brain Institute, University of Calgary, 2919 Health Sciences Centre, 3330 Hospital Drive NWt, Calgary, AB T2N 4N1 Canada
| | - Melanie Bayly
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Amanda Froehlich Chow
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Valerie Elliot
- Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Jean Daku
- Saskatchewan Health Authority, Kipling, SK Canada
| | - Tracy Hack
- Saskatchewan Health Authority, Kipling, SK Canada
| | - Faye Hoium
- Saskatchewan Health Authority, Kipling, SK Canada
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Carpenter CR, McFarland F, Avidan M, Berger M, Inouye SK, Karlawish J, Lin FR, Marcantonio E, Morris J, Reuben D, Shah R, Whitson H, Asthana S, Verghese J. Impact of Cognitive Impairment Across Specialties: Summary of a Report From the U13 Conference Series. J Am Geriatr Soc 2019; 67:2011-2017. [PMID: 31436318 PMCID: PMC6800784 DOI: 10.1111/jgs.16093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
Abstract
Although declines in cognitive capacity are assumed to be a characteristic of aging, increasing evidence shows that it is age-related disease, rather than age itself, that causes cognitive impairment. Even so, older age is a primary risk factor for cognitive decline, and with individuals living longer as a result of medical advances, cognitive impairment and dementia are increasing in prevalence. On March 26 to 27, 2018, the American Geriatrics Society convened a conference in Bethesda, MD, to explore cognitive impairment across the subspecialties. Bringing together representatives from several subspecialties, this was the third of three conferences, supported by a U13 grant from the National Institute on Aging, to aid recipients of Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) in integrating geriatrics into their subspecialties. Scientific sessions focused on the impact of cognitive impairment, sensory contributors, comorbidities, links between delirium and dementia, and issues of informed consent in cognitively impaired populations. Discussions highlighted the complexity not only of cognitive health itself, but also of the bidirectional relationship between cognitive health and the health of other organ systems. Thus, conference participants noted the importance of multidisciplinary team science in future aging research. This article summarizes the full conference report, "The Impact of Cognitive Impairment Across Specialties," and notes areas where GEMSSTAR scholars can contribute to progress as they embark on their careers in aging research. J Am Geriatr Soc 67:2011-2017, 2019.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John Morris
- Washington University School of Medicine, St. Louis, MO
| | | | - Raj Shah
- Rush University Medical Center, Chicago, IL
| | - Heather Whitson
- Duke University School of Medicine, Durham, NC and Geriatrics Research Education and Clinical Center, Durham VA, Durham, NC
| | - Sanjay Asthana
- University of Wisconsin, Madison, WI
- Albert Einstein College of Medicine, Bronx, NY
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Leggett A, Connell C, Dubin L, Dunkle R, Langa KM, Maust DT, Roberts JS, Spencer B, Kales HC. Dementia Care Across a Tertiary Care Health System: What Exists Now and What Needs to Change. J Am Med Dir Assoc 2019; 20:1307-1312.e1. [PMID: 31147289 PMCID: PMC6768732 DOI: 10.1016/j.jamda.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change. DESIGN Aimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016. SETTING AND PARTICIPANTS Forty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system. MEASURES Qualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care. RESULTS Key themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge. CONCLUSIONS AND IMPLICATIONS Five key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.
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Affiliation(s)
- Amanda Leggett
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI.
| | - Cathleen Connell
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Leslie Dubin
- School of Social Work, University of Michigan, Ann Arbor, MI; Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Ruth Dunkle
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social Research, Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Donovan T Maust
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - J Scott Roberts
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Beth Spencer
- School of Social Work, University of Michigan, Ann Arbor, MI
| | - Helen C Kales
- Program for Positive Aging and Department of Psychiatry, University of Michigan, Ann Arbor, MI
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Callahan CM, Bateman DR, Wang S, Boustani MA. State of Science: Bridging the Science-Practice Gap in Aging, Dementia and Mental Health. J Am Geriatr Soc 2019; 66 Suppl 1:S28-S35. [PMID: 29659003 DOI: 10.1111/jgs.15320] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022]
Abstract
The workforce available to care for older adults has not kept pace with the need. In response to workforce limitations and the growing complexity of healthcare, scientists have tested new models of care that redesign clinical practice. This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults. We review a general framework for the diffusion of innovations and highlight the importance of other features of innovations that deter or facilitate diffusion. Although scientists often focus on generating evidence-based innovations, end-users apply their own criteria to determine an innovation's value. In 1962, Rogers suggested six features of an innovation that facilitate or deter diffusion suggested: relative advantage, compatibility with the existing environment, ease or difficulty of implementation, trial-ability or ability to "test drive", adaptability, and observed effectiveness. We describe examples of models of care in aging, dementia and mental health that enjoy a modicum of diffusion into practice and place the features of these models in the context of deterrents and facilitators for diffusion. Developers of models of care in aging, dementia, and mental health typically fail to incorporate the complexities of health systems, the barriers to diffusion, and the role of emotion into design considerations of new models. We describe agile implementation as a strategy to facilitate the speed and scale of diffusion in the setting of complex adaptive systems, social networks, and dynamic macroenvironments.
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Affiliation(s)
- Christopher M Callahan
- Center for Aging Research, Indiana University, Indianapolis, Indiana.,Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Daniel R Bateman
- Center for Aging Research, Indiana University, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana.,Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, Indiana
| | - Sophia Wang
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, Indiana.,Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Malaz A Boustani
- Center for Aging Research, Indiana University, Indianapolis, Indiana.,Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, Indiana
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Ma C, Bao S, Dull P, Wu B, Yu F. Hospital readmission in persons with dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1170-1184. [PMID: 31087373 DOI: 10.1002/gps.5140] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/05/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. METHODS A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. RESULTS Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all-cause 30-day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home-based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. CONCLUSIONS Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high-risk individuals and the clinical reasons for index admission and readmission and implementing home-based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, NY
| | - Silin Bao
- New York University Rory Meyers College of Nursing, New York, NY
| | - Peter Dull
- New York University Rory Meyers College of Nursing, New York, NY
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY
| | - Fang Yu
- University of Minnesota School of Nursing, Minneapolis, MN
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Monahan PO, Kroenke K, Callahan CM, Bakas T, Harrawood A, Lofton P, Frye D, Draucker C, Stump T, Saliba D, Galvin JE, Keegan A, Austrom MG, Boustani M. Development and Feasibility of SymTrak, aMulti-domain Tool for Monitoring Symptoms of Older Adults in Primary Care. J Gen Intern Med 2019; 34:915-922. [PMID: 30912032 PMCID: PMC6544681 DOI: 10.1007/s11606-018-4772-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/29/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND A clinically practical, brief, user-friendly, multi-domain self-report and caregiver-report tool is needed for tracking actionable symptoms in primary care for elderly patients with multiple chronic conditions (MCCs). OBJECTIVE Develop and assess usability, administration time, and internal reliability of SymTrak. DESIGN AND PARTICIPANTS Phase I: legacy instruments, content validity, analyses of existing data, focus groups (physicians, nurses, patients, informal caregivers), and Think Aloud interviews (patients, caregivers) were used to develop SymTrak. Phase II (pilot feasibility study): 81 (27 patient-caregiver dyads, 27 patients without an identified caregiver) participants were self-administered SymTrak in clinic. MAIN MEASURES SymTrak and demographic questions. KEY RESULTS Consistent themes emerged from phase I focus groups. Ambiguous wording was corrected with Think Aloud feedback. In phase II, patients and caregivers preferred circling words instead of numbers for item response options. SymTrak self-administration completion time in clinic was brief; mean was 2.4, 3.0, and 3.3 min for the finalized circlingwords version, respectively, for caregivers, dyadic patients, and patients without a caregiver; and the maximum was 6.2 min for any participant. Usability questionnaire ratings were high. Cronbach's alpha for the SymTrak 23-item total score was 0.86, 0.79, and 0.81 for caregivers, dyadic patients, and patients without a caregiver, respectively. CONCLUSIONS SymTrak demonstrates content validity, positive qualitative findings, high perceived usability, brief self-administered completion time, and good internal reliability.
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Affiliation(s)
- Patrick O Monahan
- Indiana University School of Medicine, Indianapolis, IN, USA. .,Indiana University School of Public Health, Indianapolis, IN, USA.
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, IN, USA.,VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Christopher M Callahan
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Tamilyn Bakas
- Indiana University School of Nursing, Indianapolis, IN, USA
| | - Amanda Harrawood
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Phillip Lofton
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Danielle Frye
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | | | - Timothy Stump
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Debra Saliba
- University of California Borun Center and Veterans Administration, Los Angeles, CA, USA
| | - James E Galvin
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Amanda Keegan
- Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Mary G Austrom
- Indiana University Department of Psychiatry, Indianapolis, IN, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Indiana University Center for Aging Research, Indianapolis, IN, USA
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Churruca K, Pomare C, Ellis LA, Long JC, Braithwaite J. The influence of complexity: a bibliometric analysis of complexity science in healthcare. BMJ Open 2019; 9:e027308. [PMID: 30904877 PMCID: PMC6475366 DOI: 10.1136/bmjopen-2018-027308] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To analyse trends in the academic literature applying complexity science to healthcare, focusing specifically on bibliometric characteristics and indicators of influence. DESIGN This study reports a bibliometric analysis via a systematic search of the academic literature applying complexity science to healthcare. METHOD A search of four academic databases was performed on 19 April 2018. Article details were downloaded and screened against inclusion criteria (peer-reviewed journal articles applying complexity science to healthcare). Publication and content data were then collected from included articles, with analysis focusing on trends over time in the types and topics of articles, and where they are published. We also analysed the influence of this body of work through citation and network analyses. RESULTS Articles on complexity science in healthcare were published in 268 journals, though a much smaller subset was responsible for a substantial proportion of this literature. USA contributed the largest number of articles, followed by the UK, Canada and Australia. Over time, the number of empirical and review articles increased, relative to non-empirical contributions. However, in general, non-empirical literature was more influential, with a series of introductory conceptual papers being the most influential based on both overall citations and their use as index references within a citation network. The most common topics of focus were health systems and organisations generally, and education, with recent uptake in research, policy, and change and improvement. CONCLUSIONS This study identified changes in the types of articles on complexity science in healthcare published over time, and their content. There was evidence to suggest a shift from conceptual work to the application of concrete improvement strategies and increasingly in-depth examination of complex healthcare systems. We also identified variation in the influence of this literature at article level, and to a lesser extent by topic of focus.
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Affiliation(s)
- Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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Jennings LA, Laffan AM, Schlissel AC, Colligan E, Tan Z, Wenger NS, Reuben DB. Health Care Utilization and Cost Outcomes of a Comprehensive Dementia Care Program for Medicare Beneficiaries. JAMA Intern Med 2019; 179:161-166. [PMID: 30575846 PMCID: PMC6439653 DOI: 10.1001/jamainternmed.2018.5579] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE An estimated 4 to 5 million Americans have Alzheimer disease or another dementia. OBJECTIVE To determine the health care utilization and cost outcomes of a comprehensive dementia care program for Medicare fee-for-service beneficiaries. DESIGN, SETTING, AND PARTICIPANTS In this case-control study, we used a quasiexperimental design to compare health care utilization and costs for 1083 Medicare fee-for-service beneficiaries enrolled in the University of California Los Angeles Health System Alzheimer and Dementia Care program between July 1, 2012, and December 31, 2015, with those of 2166 similar patients with dementia not participating in the program. Patients in the comparison cohort were selected using the zip code of residence as a sampling frame and matched with propensity scores, which included demographic characteristics, comorbidities, and prior-year health care utilization. We used Medicare claims data to compare utilization and cost outcomes for the 2 groups. INTERVENTIONS Patients in the dementia care program were comanaged by nurse practitioners and physicians, and the program consisted of structured needs assessments of patients and their caregivers, creation and implementation of individualized dementia care plans with input from primary care physicians, monitoring and revising care plans, referral to community organizations for dementia-related services and support, and access to a clinician for assistance and advice 24 hours per day, 7 days per week. MAIN OUTCOMES AND MEASURES Admissions to long-term care facilities; average difference-in-differences per quarter over the 3-year intervention period for all-cause hospitalization, emergency department visits, 30-day hospital readmissions, and total Medicare Parts A and B costs of care. Program costs were included in the cost estimates. RESULTS Program participants (n = 382 men, n = 701 women; mean [SD] age, 82.10 [7.90] years; age range 54-101 years) were less likely to be admitted to a long-term care facility (hazard ratio, 0.60; 95% CI, 0.59-0.61) than those not participating in the dementia care program (n = 759 men, n = 1407 women; mean [SD] age, 82.42 [8.50] years; age range, 34-103 years). There were no differences between groups in terms of hospitalizations, emergency department visits, or 30-day readmissions. The total cost of care to Medicare, excluding program costs, was $601 less per patient per quarter (95% CI, -$1198 to -$5). After accounting for the estimated program costs of $317 per patient per quarter, the program was cost neutral for Medicare, with an estimated net cost of -$284 (95% CI, -$881 to $312) per program participant per quarter. CONCLUSIONS AND RELEVANCE Comprehensive dementia care may reduce the number of admissions to long-term care facilities, and depending on program costs, may be cost neutral or cost saving. Wider implementation of such programs may help people with dementia stay in their communities.
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Affiliation(s)
- Lee A Jennings
- Reynolds Department of Geriatric Medicine at the University of Oklahoma Health Sciences Center, Oklahoma City
| | | | | | - Erin Colligan
- Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Baltimore, Maryland
| | - Zaldy Tan
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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Boustani M, Alder CA, Solid CA, Reuben D. An Alternative Payment Model To Support Widespread Use Of Collaborative Dementia Care Models. Health Aff (Millwood) 2019; 38:54-59. [DOI: 10.1377/hlthaff.2018.05154] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Malaz Boustani
- Malaz Boustani is the Richard M. Fairbanks Professor of Aging Research at Indiana University School of Medicine; director of the Center for Health Innovation and Implementation Science at both the Indiana Clinical and Translational Sciences Institute and the Regenstrief Institute Inc.; and the chief innovation and implementation officer at the Sandra Eskenazi Center for Brain Care Innovation (within Eskenazi Health), all in Indianapolis
| | - Catherine A. Alder
- Catherine A. Alder is manager of business and research operations at the Sandra Eskenazi Center for Brain Care Innovation, in Indianapolis
| | - Craig A. Solid
- Craig A. Solid is owner of Solid Research Group, LLC, in Saint Paul, Minnesota
| | - David Reuben
- David Reuben is director of the Multicampus Program in Geriatric Medicine and Gerontology and the Archstone Professor of Medicine/Geriatrics at the David Geffen School of Medicine, University of California Los Angeles
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46
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Austrom MG, Boustani M, LaMantia MA. Ongoing Medical Management to Maximize Health and Well-being for Persons Living With Dementia. THE GERONTOLOGIST 2018; 58:S48-S57. [PMID: 29361066 DOI: 10.1093/geront/gnx147] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Persons living with dementia have complex care needs including memory loss that should be taken into account by providers and family caregivers involved with their care. The prevalence of comorbid conditions in people with dementia is high and, thus, how primary care, community providers and family caregivers provide best practice care, person-centered care is important. Research Design and Methods Care providers should understand the ongoing medical management needs of persons living with dementia in order to maximize their quality of life, proactively plan for their anticipated needs, and be as well prepared as possible for health crises that may occur. Results This article provides eight practice recommendations intended to promote understanding and support of the role of nonphysician care providers in educating family caregivers about ongoing medical management to improve the wellbeing of persons living with dementia. Discussion and Implications Key among these are recommendations to use nonpharmacological interventions to manage behavioral and psychological symptoms of dementia as the first line of treatment and recommendations on how to best support the use and discontinuation of pharmacological interventions as necessary.
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Affiliation(s)
- Mary Guerriero Austrom
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis.,Office of Diversity Affairs, Indiana University School of Medicine, Indianapolis
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis.,Regenstrief Institute Inc., Indiana University School of Medicine, Indianapolis
| | - Michael A LaMantia
- Division of General Internal Medicine and Geriatrics, University of Vermont, Burlington.,University of Vermont Center on Aging, Burlington
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Does the community-based combined Meeting Center Support Programme (MCSP) make the pathway to day-care activities easier for people living with dementia? A comparison before and after implementation of MCSP in three European countries. Int Psychogeriatr 2018; 30:1717-1734. [PMID: 29436322 DOI: 10.1017/s1041610217002885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The "pathway to care" concept offers a helpful framework for preparing national dementia plans and strategies and provides a structure to explore the availability and accessibility of timely and effective care for people with dementia and support for their informal carers. Within the framework of the JPND-MEETINGDEM implementation project the pathways to regular day-care activities and the Meeting Centers Support Programme (MCSP), an innovative combined support form for people with dementia and carers, was explored. METHODS An exploratory, descriptive, qualitative, cross-country design was applied to investigate the pathways to day care in several regions in four European countries (Italy, Poland, United Kingdom, and the Netherlands). RESULTS Before implementation of MCSP, of the four countries the United Kingdom had the most structured pathway to post-diagnostic support for people with dementia. MCSP introduction had a positive impact on the pathways to day-care activities in all countries. MCSP filled an important gap in post-diagnostic care, increasing the accessibility to support for both people with dementia and carers. Key elements such as program of activities, target group, and collaboration between healthcare and social services were recognized as success factors. CONCLUSIONS This study shows that MCSP fills (part of) the gap between diagnosis and residential care and can therefore be seen as a pillar of post-diagnostic care and support. Further dissemination of Meeting Centers in Europe may have a multiple impact on the structure of dementia services in European countries and the pathways to day care for people with dementia and their carer(s).
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Clarifying Values and Preferences for Care Near the End of Life: The Role of a New Lay Workforce. J Community Health 2018; 42:926-934. [PMID: 28353007 DOI: 10.1007/s10900-017-0336-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community health workers (CHWs) can engage elderly persons in advance care planning (ACP) conversations. We report how trained CHWs used Go Wish cards (GW R cards) to identify patients' highest priority preferences and evaluated whether engaging in ACP conversations was associated with subsequent health care utilization. A one-year long, pre-post longitudinal design was used to evaluate our educational intervention using mixed-methods. 392 patients (mean of 73.3 years, 82% women, 48% African American, 43% Caucasian) enrolled in the Aging Brain Care (ABC) program and participated in ACP discussions with CHWs. We expanded the role of the ABC's CHW, who work directly with individuals and caregivers during home visits to monitor bio-psycho-social needs, to include ACP conversations. The CHWs received ACP training, practice with tools such as GW R cards, and support from an electronic health record (EHR) clinical decision support tool. Quantitative measures of patients' ACP preferences and health care utilization were abstracted from the EHR. Qualitative data about patients' perceptions of CHWs in facilitating ACP discussions was obtained through semi-structured interviews. Eighty-six patients' data indicated that they had engaged in a preferences-for-care process using GW R cards. The top-three card choices by patients was attending to spirituality and religious concerns, preparing for end of life, and maintaining personal wholeness. CHWs were able to effectively engage in ACP conversations with patients and GW R cards were a positive way to stimulate discussion of issues previously undiscussed.
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49
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Wagle KC, Skopelja EN, Campbell NL. Caregiver-Based Interventions to Optimize Medication Safety in Vulnerable Elderly Adults: A Systematic Evidence-Based Review. J Am Geriatr Soc 2018; 66:2128-2135. [PMID: 30136714 DOI: 10.1111/jgs.15556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To study the effect of caregiver-focused interventions to support medication safety in older adults with chronic disease. DESIGN Systematic review. SETTING Studies published before January 31, 2017, searched using Ovid Medline, PubMed, EMBASE, Scopus, CINAHL, PsycINFO, and Google Scholar. PARTICIPANTS Caregivers with or without a care recipient. MEASUREMENTS Inclusion criteria: interventions focused on caregivers aiming to improve medication safety. Studies not focusing on older adults, not evaluating medication safety, failing to include caregivers, or without a comparison group were excluded. RESULTS The initial search revealed 1,311 titles. Eight studies met inclusion criteria. The strategies used in randomized trials were a home-based medication review and adherence assessment by a clinical pharmacist (2 home visits 6-8 weeks apart, with pharmacist and physician meeting independently) that found no difference in nonelective hospital admissions (p=.8) but fewer medications (p=.03); a 19-minute educational DVD and an hour-long medication education and training that improved caregiver satisfaction (p<.04); a medication education and adherence intervention (2-3 home visits per care recipient and caregiver dyad over 8 weeks) that found no difference in knowledge, administration, or accessibility of medications (p=.29); and a collaborative case management program (16-month program of assessment, meeting, and monthly follow-up telephone calls) that reduced perceived caregiver burden (p=.03). Quasi-experimental trials included collaborative care transitional coaches, an outpatient collaborative care model, and education and training programs. Of these, educational interventions showed improvements in self-efficacy, confidence, and preparedness. The collaborative care intervention reduced rehospitalizations (p=.04) and improved quality-of-care outcomes. CONCLUSION Although some interventions improved caregiver medication knowledge and self-efficacy, effects on clinical outcomes and healthcare use were insufficiently studied. Two studies implementing collaborative care models with medication management components showed potential for improvement in quality of clinical care and reductions in healthcare visits and warrant further study with respect to medication safety. J Am Geriatr Soc 66:2128-2135, 2018.
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Affiliation(s)
- Kamal C Wagle
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Elaine N Skopelja
- Ruth Lilly Medical Library, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Noll L Campbell
- College of Pharmacy, Purdue University, Lafayette, Indiana.,Center for Aging Research, Indiana University, Indianapolis, Indiana
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Harrawood A, Fowler NR, Perkins AJ, LaMantia MA, Boustani MA. Acceptability and Results of Dementia Screening Among Older Adults in the United States. Curr Alzheimer Res 2018; 15:51-55. [PMID: 28891444 PMCID: PMC5963533 DOI: 10.2174/1567205014666170908100905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. DESIGN Cross-sectional study of primary care patients aged 65 and older. SETTING Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. PARTICIPANTS Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. MEASUREMENTS Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. RESULTS Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. CONCLUSION Age and perceived problems with memory are associated with screening positive for dementia in primary care.
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Affiliation(s)
- Amanda Harrawood
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Michael A. LaMantia
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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