Improving Post-Diagnosis Dementia Care in Primary Care

项目总结 Halima Amjad博士是医学助理教授，也是临床老年医学执业医师 约翰霍普金斯大学医学院在阿尔茨海默氏症和相关痴呆症方面的专业知识。 她的长期职业目标是成为以患者为导向、提供信息和改进的研究领域的领导者 通过制定和实施护理服务为老年痴呆症患者提供医疗服务 临床实践中的干预。这一奖项将确保她拥有足够的知识、技能和经验 制定有效的干预措施，领导临床试验，并将研究成果转化为常规临床护理。这个 职业发展计划提出了为期五年的混合方法研究的非正式和正式培训， 干预措施开发和测试，包括临床试验和实施科学，重点是 阿尔茨海默病和相关痴呆症。Amjad博士召集了一支杰出的导师团队， 在相关研究方法、痴呆症护理、初级护理和复杂老年人护理方面的专业知识。 这项提议将在一个丰富的科学环境中进行，并提供必要的资源来支持她 研究、职业发展和向独立临床研究过渡。 尽管痴呆症给患者、家庭和卫生系统带来了越来越大的负担，但大多数老年人 患有痴呆症的成年人在确诊后接受不太理想的痴呆症治疗。临床实践指南 痴呆症治疗是可用的，但并不广为人知，也没有得到始终如一的遵循。最新的卫生系统 变化，包括新的医疗保险报销机制和采用电子病历 (急诊室)，提供了在繁忙的初级保健环境中改善痴呆症诊断后护理的机会。这个 Proposal利用这些机会应对临床实践转型的复杂挑战 并将诊断与及时、高质量的痴呆症护理联系起来。目标1和目标2使用混合方法方法 (初级保健提供者和多学科工作人员调查和访谈、患者和家属访谈) 了解诊断后痴呆症护理的障碍和促进者，关键利益相关者对 痴呆症护理的组成部分和战略，以及对综合、多学科的可行性的认识 诊断后痴呆症护理干预。结果将通知以干预为中心的适应 围绕AIM 3的初级保健中的结构化诊断后痴呆症护理访问。实施将利用 EMR和Medicare为痴呆症护理报销带来与痴呆症相关的评估和支持工具 提供初级保健服务。干预的可行性和可接受性将在一个初级保健诊所进行测试， 为未来评估干预效果的多点实用随机对照试验奠定基础 在改善护理质量和患者预后方面发挥重要作用。该提案解决了一个重大挑战(痴呆症 在一个重要的环境(初级保健)。它将导致一种可广泛实施的干预措施，并 临床调查员准备改变痴呆症患者的医疗保健。

PROJECT SUMMARY Dr. Halima Amjad is an Assistant Professor of Medicine and practicing geriatrician with clinical expertise in Alzheimer's disease and related dementias at the Johns Hopkins University School of Medicine. Her long-term career goal is to become a leader in patient-oriented research that informs and improves medical care for older adults with dementia through the development and implementation of care delivery interventions in clinical practice. This award will ensure she has the knowledge, skills, and experience to develop effective interventions, lead clinical trials, and translate research findings into routine clinical care. The career development plan proposes five years of informal and formal training in mixed methods research, intervention development and testing including clinical trials, and implementation science focused on Alzheimer's disease and related dementias. Dr. Amjad has convened an outstanding mentorship team with expertise in the relevant research methods, dementia care, primary care, and care for complex older adults. The proposal will take place in a rich scientific environment with the resources necessary to support her research, career development, and transition to independent clinical investigation. Despite the growing burden of dementia on patients, families, and health systems, the majority of older adults with dementia receive suboptimal care for dementia after diagnosis. Clinical practice guidelines for dementia care are available, but are not widely known or consistently followed. Recent health systems changes, including new Medicare reimbursement mechanisms and uptake of electronic medical records (EMRs), present opportunities to improve post-diagnosis care for dementia in busy primary care settings. The proposal leverages these opportunities to address the complex challenges of clinical practice transformation and linking diagnosis to timely, high quality dementia care. Aims 1 and 2 use a mixed methods approach (primary care provider and multidisciplinary staff surveys and interviews, patient and family interviews) to understand barriers and facilitators to post-diagnosis dementia care, key stakeholder perspectives on essential components and strategies for dementia care, and perceived feasibility of a comprehensive, multidisciplinary post-diagnosis dementia care intervention. Results will inform the adaptation of an intervention centered around a structured post-diagnosis dementia care visit in primary care in Aim 3. Implementation will leverage EMRs and Medicare reimbursement for dementia care to bring dementia-related assessment and support tools to primary care. Feasibility and acceptability of the intervention will be tested in one primary care clinic, laying the groundwork for a future multisite pragmatic randomized controlled trial to assess intervention effectiveness in improving quality of care and patient outcomes. The proposal addresses a significant challenge (dementia care) in an important setting (primary care). It will lead to an intervention that can be widely implemented and a clinical investigator poised to transform medical care for persons living with dementia.