BACKGROUND/RATIONALE:
Partners in Dementia Care (PDC) is a care-coordination and support service intervention for veterans with dementia and their family caregivers, delivered through partnerships between VA medical centers and local Alzheimer's Association Chapters. PDC was created on the basis of 7 years of research and development and was designed to be a feasible and practical intervention to integrate health, community, and support services. It has a standardized protocol for care coordination and support services, including guidelines for care-plan assessment, care plan development and implementation, ongoing monitoring, and reassessment. It also offers a structured training curriculum for providers and an operations manual for uniform implementation.
OBJECTIVE(S):
The primary objective of this investigation is to rigorously test the impact of PDC on a number of outcomes for veterans with dementia, family caregivers, and healthcare providers. Within VA Medical Centers, the focus will be on improving dementia care in primary care clinics, including geriatrics.
Two specific research objectives and corresponding hypotheses will be addressed:
1. To test the impact of PDC on three categories of outcomes: psychosocial well-being outcomes (patient and caregiver effects); healthcare service use (patient effects only); and health care cost (patient effects only).
HI:PDC, compared with usual care, will improve psychosocial well-being, including depression, health status, adequacy of care, and quality of care for patients with dementia and their caregivers.
H2:PDC, compared with usual care, will reduce healthcare service use for patients with dementia, including hospital admissions, emergency department visits, nursing home admissions, and physician visits.
H3:PDC is preferred to usual care, based on cost-effectiveness and cost-benefit analyses.
H4:The PDC intervention will be more effective than usual care in improving psychosocial well-being and reducing health care service use for patients and caregivers dealing with more severe patient impairment (e.g., cognitive status, functional status, and level of problem behaviors).
2. To evaluate the impact of PDC on role and intra-psychic strains caused by dementia and its care (patient and caregiver effects).
H5a:PDC, compared with usual care, will decrease patient role and intra-psychic strain, including embarrassment about the illness, emotional strain, relationship strain, and social isolation.
H5b:PDC, compared with usual care, will decrease caregiver role and intra-psychic strain, including role captivity, work care-related strain, relationship strain, emotional and physical health deterioration, and caregiving efficacy.
H6:The PDC intervention will be more effective than usual care in decreasing role and intra-psychic strains for patients and caregivers dealing with more severe patient impairment (e.g., cognitive status, functional status, and level of problem behaviors).
If effective, the long-term objective is to implement PDC in a regional, Quality Enhancement Research Initiative (QUERI)-like demonstration involving 30 to 40 VA medical centers. Additionally, the PDC approach will be adapted for other chronic conditions (e.g., heart disease, COPD, diabetes).
METHODS:
The proposed study is a 49-month, controlled trial of PDC. The intervention will be implemented at two intervention sites and two comparison sites matched on organizational, provider, and patient characteristics.
FINDINGS/RESULTS:
There are no findings at this time.
IMPACT:
The VA has put a high emphasis on improving the quality of dementia care throughout the VA which is illustrated by a recent VA dementia steering committee meeting and an upcoming VA dementia conference. The Partners in Dementia Care study has the potential to be an exemplar of dementia care for veterans and their caregivers.
PUBLICATIONS:
Journal Articles
- Farrell TW, Dosa D. The assessment and management of hypoactive delirium. Medicine and Health, Rhode Island. 2007; 90(12): 393-5.
- Gruneir A, Miller SC, Intrator O, Mor V. Hospitalization of nursing home residents with cognitive impairments: the influence of organizational features and state policies. The Gerontologist. 2007; 47(4): 447-56.
- Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Services Research. 2007; 42(4): 1651-71.
- Dosa D, Intrator O, McNicoll L, Cang Y, Teno J. Preliminary derivation of a Nursing Home Confusion Assessment Method based on data from the Minimum Data Set. Journal of The American Geriatrics Society. 2007; 55(7): 1099-105.
- Dosa D, McNicoll L. Infections in the nursing home: a primer for the practicing physician. Medicine and Health, Rhode Island. 2007; 90(7): 211-2, 216-7.
- Zinn JS, Mor V, Feng Z, Intrator O. Doing better to do good: the impact of strategic adaptation on nursing home performance. Health Services Research. 2007; 42(3 Pt 1): 1200-18.
- Mitchell SL, Teno JM, Intrator O, Feng Z, Mor V. Decisions to forgo hospitalization in advanced dementia: a nationwide study. Journal of The American Geriatrics Society. 2007; 55(3): 432-8.
