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

项目摘要/摘要 痴呆症给患者、他们的照顾者和医疗保健系统带来了沉重的负担。最近和 医疗政策的潜在变化表明了向可持续的报销模式的转变 循证痴呆症护理。目前，痴呆症的最佳实践与实际存在很大差距。 世界关怀快递。可扩展、高效且以患者为中心的痴呆症护理模式 现在需要报销改革的趋势。关怀生态系统是一项痴呆症支持计划， 将有效计划的要素结合到一个可扩展的模型中，该模型可以在新策略中取得成功 环境。护理由经过培训的无证护理团队导航员通过电话和网络提供 并由护士、社会工作者和药剂师监督。主动式护理模块侧重于护理者支持 以及教育、药物咨询、围绕医疗、财务和法律决策以及行为的支持 管理层。我们正在评估关怀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照顾者，具有一系列社会经济特征，以及 研究对象包括说西班牙语和广东话的人。短期(6个月)结果表明 受益，我们希望我们的护理计划的最大影响将在所有人的长期中实现 痴呆症的各个阶段。这一拟议的项目将继续在我们现有的队列中进行护理和衡量，以 确定5年的治疗效果，并确定最有可能受益的患者和照顾者的特征。在……里面 目标1，我们将评估护理生态系统对患者生活质量、养老院安置时间、 护理成本、照顾者负担、抑郁和整个疾病轨迹的健康。在目标2中，我们将 确定城乡地区、家庭收入、少数民族状况以及 根据行为症状的严重程度、照顾者的负担和社会孤立程度。在目标3中，我们将确定 临终关怀生态系统对临终关怀的影响通过阐明此可扩展的 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 向哪些受益人提供痴呆症护理服务。此外，成果将提供一个框架，以 在整个护理连续体中照顾不同人群的患者和照顾者。

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.