Improving Alzheimer's Disease and Related Dementias Care in Rural Areas

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1 This is an application for a K01 award for Beth Prusaczyk, PhD, MSW, whose research focuses 2 on improving the health of vulnerable older adults, such as those with Alzheimer’s disease and 3 related dementias (ADRD) living in rural areas, by improving systems of care. The experiences 4 of those in rural areas with ADRD, including the older adults with ADRD, their caregivers, their 5 health and social service providers, and their community, are distinctly different from those in 6 urban areas. A lack of integration between services is a barrier to caregivers receiving information. 7 Providers desire more integrated services, such as having case managers at primary care offices 8 to help coordinate social services. Failure to improve the communication and care coordination 9 across rural ADRD networks as the aging population increases will compound these existing 10 disparities and result in poorer care for older adults with ADRD in rural settings. Health Information 11 Technology (HIT) tools, such as telehealth, clinical decision support, mobile applications, 12 electronic referrals or prescribing, and others, have been applied in rural areas to ADRD disease 13 risk, testing, and diagnosis, but have not yet been applied to communication and care 14 coordination. The purpose of this K01 is to build off preliminary data and use network analysis to 15 identifying communication and care coordination gaps in two rural ADRD care systems then, in 16 collaboration with local older adults with ADRD, their caregivers, their health and social service 17 providers, select and pilot test a HIT tool to fill those gaps. Specifically, this study will: 1) build 18 network models of communication and care coordination within two rural ADRD networks, and 19 identify factors related to communication and care coordination gaps; 2) assess the perceived 20 usability, feasibility, and acceptability of HIT tools designed to address communication and care 21 coordination in the networks and select a HIT tool to pilot test; and 3) pilot test the communication 22 and care coordination HIT tool in the network. Through this K01 award, Dr. Prusaczyk, who is a 23 health services researcher at Washington University School of Medicine in St. Louis (WUSM), will 24 improve upon and address gaps in her skill set through targeted training activities in: 1) advanced 25 network analysis; 2) HIT; and 3) rural ADRD research. These activities will be possible through 26 resources available at WUSM, including the Knight Alzheimer’s Disease Research Center and 27 the Institute for Informatics. Dr. Prusaczyk has the support of an outstanding mentorship team 28 with expertise in ADRD, network analysis, rural health services research, and HIT. This research 29 is significant because it will yield a comprehensive understanding of rural ADRD systems – a 30 critical context for which there is limited knowledge – and a possible solution for improvement.