Team-Based Care Needed for Dementia Patients
With rates of dementia expected to rise as the baby boomer population ages, more efficient and effective models for dementia care will be paramount in the years to come.
Investigators from the Regenstrief Institute recently reviewed two new models for dementia care designed to decrease caregiver stress, reduce health care costs, and improve quality of life for patients with dementia. Their findings appear in the April issue of Health Affairs.
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The researchers summarized the origins, evidence base, and common components of two dementia care models that offer promise for implementation on a national scale:
• Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC), and
• the Healthy Aging Brain Center.
Both models were developed by clinician-researchers from the Regenstrief Institute and Indiana University, with support from the Center for Medicare and Medicaid Innovation and in collaboration with Eskenazi Health.
“Each model focuses on a team-based approach to care, with a recognition that most of the hands-on, day-to-day care will be provided by family caregivers or direct care workers and these hands-on providers need the support of the team,” says lead author Christopher M. Callahan, MD, an investigator at the Regenstrief Institute and founding director of the Indiana University Center for Aging Research in Indianapolis. “Each of the models provides the care team with tools to assess the care recipient and these assessments, when they reveal problems, are linked to suggestions for treatment, prevention, or other interventions.”
In both models, the patient’s wishes play an important role in devising goals for care, and collaboration between the medical team and the caregivers are crucial to attaining them. The models not only seek to improve quality of care and outcomes, but also exhibit cost savings in community-based and institutional care settings.
Callahan and colleagues looked at how this research might be implemented in the real world—considering the benefits as well as the barriers. “Knowledge generated in clinical trials shows that an intervention can work; however, there are many other next steps between new knowledge and putting that knowledge into practice,” he explains. “Implementation science is a relatively new branch of research that seeks to understand and overcome barriers to widespread adoption.”
Right now, Callahan says neither of the models is anywhere close to widespread adoption. “The main limitations are that these models will require practice redesign, a new workforce, and new reimbursement schemes,” he says. “However, these two projects are seeking to provide the data that would demonstrate that these new models are effective at scale and that they can provide quality care at a price the country is willing to pay.”
—Colleen Mullarkey
Reference
Callahan CM, Sachs GA, Lamantia MA, Unroe KT, Arling G, Boustani MA. Redesigning systems of care for older adults with Alzheimer’s disease. Health Aff (Millwood). 2014 Apr;33(4):626-32.