The Care Ecosystem: Navigating patients and caregivers through stages of dementia care

项目概要/摘要 痴呆症给患者、他们的照顾者和卫生保健系统造成了巨大的负担。最近和 医疗保健政策的潜在变化表明， 循证痴呆症护理目前，痴呆症的最佳实践与真实的之间存在很大差距 世界护理交付。可扩展的，有效的，以患者为中心的痴呆症护理模式， 现在需要在偿还改革方面形成趋势。护理生态系统是一个痴呆症支持计划， 将有效计划的要素组合成一个可扩展的模型， 环境护理由经过培训的无执照护理团队导航员通过电话和网络提供 由护士社工和药剂师监督主动护理模块侧重于护理人员支持 教育、药物咨询、医疗、财务和法律的决策以及行为方面的支持 管理我们正在评估护理生态系统对心理社会和经济的短期影响。 由医疗保险和医疗补助创新中心资助的随机对照试验的结果。 来自农村和城市地区的患者和护理人员，具有一系列社会经济特征，以及 包括西班牙语和广东话人士。短期（6个月）结果表明 受益，我们预计，我们的护理计划的最大影响将在所有长期实现 痴呆的阶段。这个拟议的项目将继续在我们现有的队列的护理和测量， 确定5年的治疗效果，并描述最有可能受益的患者和护理人员。在 目的1，我们将评估护理生态系统对患者生活质量，到疗养院安置的时间， 护理成本，护理人员负担，抑郁症和整个疾病轨迹的健康。在目标2中，我们 确定农村/城市地区、家庭收入、少数民族地位的差别待遇效果， 行为症状的严重程度，照顾者的负担，和社会孤立。在目标3中，我们将确定 护理生态系统对死亡患者临终护理的影响。通过澄清这种可扩展的 痴呆症护理计划，我们的项目将提供重要的指导，因为卫生系统决定什么 老年痴呆症护理服务提供和受益人。此外，成果将提供一个框架， 在整个护理过程中照顾不同的患者和护理人员。

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients, their caregivers, and health care systems. Recent and potential changes in health care policy indicate a shift towards reimbursement models that could sustain evidence-based dementia care. Currently, there is a wide gap between best practice in dementia and real- world care delivery. Scalable, effective, and patient-centered dementia care models that are aligned with trends in reimbursement reform are needed now. The Care Ecosystem is a dementia support program that combines elements of effective programs into a scalable model that could be successful in the new policy environment. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a nurse, social worker, and pharmacist. Proactive care modules focus on caregiver support and education, medication consultation, support around medical, financial, and legal decisions, and behavior management. We are evaluating the short-term impact of the Care Ecosystem on psychosocial and economic outcomes in a randomized controlled trial, funded by the Centers for Medicare and Medicaid Innovation. Patients and caregivers from rural and urban locales, with a range of socioeconomic characteristics, and cohorts of Spanish and Cantonese speaking persons are included. Short-term (6 month) results suggest benefit, and we expect that the greatest impact of our care program will be realized in the long term across all stages of dementia. This proposed project would continue the care and measurement in our existing cohort to determine the 5-year treatment effects and to characterize the patients and caregivers most likely to benefit. In Aim 1, we will evaluate the Care Ecosystem's effects on patient quality of life, time to nursing home placement, cost of care, and caregiver burden, depression, and health across the disease trajectory. In Aim 2, we will determine the differential treatment effects by rural/urban locale, household income, ethnic minority status, and by severity of behavioral symptoms, caregiver burden, and social isolation. In Aim 3, we will determine the effects of Care Ecosystem on end of life care among patients who die. By clarifying the impacts of this scalable dementia care program, our project would provide important guidance as health systems determine what dementia care services to provide and to which beneficiaries. In addition, results would provide a framework for caring for a diverse population of patients and caregivers across the care continuum.