Improving Post-Diagnosis Dementia Care in Primary Care

项目摘要 Halima Amjad博士是医学助理教授和临床实践老年病学家， 约翰霍普金斯大学医学院阿尔茨海默病和相关痴呆症的专家。 她的长期职业目标是成为以患者为导向的研究的领导者， 通过制定和实施护理服务，为老年痴呆症患者提供医疗护理 临床实践中的干预。这个奖项将确保她有知识，技能和经验， 制定有效的干预措施，领导临床试验，并将研究结果转化为常规临床护理。的 职业发展计划建议在混合方法研究方面进行五年的非正式和正式培训， 干预开发和测试，包括临床试验，以及实施科学，重点是 阿尔茨海默氏病及相关痴呆症。Amjad博士召集了一个杰出的导师团队， 在相关的研究方法，痴呆症护理，初级保健和复杂的老年人护理的专业知识。 该提案将在一个丰富的科学环境中进行，并有必要的资源来支持她。 研究，职业发展，并过渡到独立的临床研究。 尽管老年痴呆症给患者、家庭和卫生系统带来的负担越来越重，但大多数老年人仍然面临着严重的健康问题。 患有痴呆症的成年人在诊断后接受的痴呆症护理不够理想。临床实践指南 痴呆症护理是可用的，但并不广为人知或一贯遵循。最近的卫生系统 变化，包括新的医疗保险报销机制和采用电子病历 （EMR），目前的机会，以改善诊断后照顾痴呆症在忙碌繁忙的初级保健设置。的 提案利用这些机会来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2采用混合方法 （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因素， 组成部分和战略的痴呆症护理，以及感知的可行性，全面的，多学科的 诊断后痴呆症护理干预。结果将告知以干预为中心的调整 围绕目标3中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 为痴呆症护理提供EMR和Medicare报销，以提供痴呆症相关评估和支持工具 到初级保健。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， 为未来多中心实用随机对照试验评估干预有效性奠定基础 提高医疗质量和病人的治疗效果。该提案解决了一个重大挑战（痴呆症 在一个重要的设置（初级保健）。它将导致一种可以广泛实施的干预措施， 临床研究人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.