PossinK, NIH, R01 Supplement P0568851 4/4/2023

项目总结/摘要 痴呆症给患者和护理人员带来了沉重的负担，而COVID-19又加剧了这种负担。 流行病目前的痴呆症护理状况不足以满足这一日益增长的脆弱群体的需求。 人口可扩展、有效和以人为本的痴呆症护理模式，与基于价值的 现在需要医疗改革。护理生态系统是一个可访问的、远程交付的、基于团队的 痴呆症护理模式，旨在为患者，提供者和支付者在复杂的组织和 偿还结构。护理是通过电话和网络提供的未经许可的护理团队导航，谁 由一组具有护理、社会工作和药学专业知识的痴呆症专家进行培训和监督。 护理协议指导记录在电子健康记录中的积极主动的高质量护理。证据 迄今为止的基础表明，护理生态系统改善了对痴呆症患者重要的结果， 在受控的研究环境中交付时，包括减少紧急情况， 部门访问，减少多种药物，提高患者的生活质量和降低护理人员的抑郁症。与 我们的母项目，我们正在6个卫生系统进行快速务实的试验， 文化多样的人口。有了这个补充，我们将在真实的时间解决意外的挑战， 确保我们按计划完成项目，达到招生目标并遵守我们的时间轴。在Aim中 1，我们将加强招募拉丁裔/西班牙裔，黑人/非洲裔美国人和农村参与者。在目标2中， 扩大我们的临床团队，使他们能够管理高需求的患者，承担更大的病例量，并提供 对所有患者公平的药物治疗方案。在目标3中，我们将支付在访问 以及管理电子健康记录数据。这项工作将为扩大获得高质量的 未来的痴呆症护理，减轻痴呆症对患者及其家庭的负面影响， 民族

PROJECT SUMMARY/ABSTRACT Dementia causes substantial burdens for patients and caregivers, which were exacerbated by the COVID-19 pandemic. The current state of dementia care is inadequate to meet the needs of this growing, vulnerable population. Scalable, effective, and person-centered dementia care models that are aligned with value-based healthcare reforms are needed now. The Care Ecosystem is an accessible, remotely delivered team-based dementia care model, designed to add value for patients, providers and payers in complex organizational and reimbursement structures. Care is delivered via the phone and web by unlicensed Care Team Navigators, who are trained and supervised by a team of dementia specialists with nursing, social work, and pharmacy expertise. Care Protocols guide proactive, quality care that is documented in the electronic health record. The evidence base to date suggests that the Care Ecosystem improves outcomes important to people with dementia, caregivers, and payers when delivered in a controlled research environment, including reduced emergency department visits, reduced polypharmacy, higher quality of life for patients and lower caregiver depression. With our parent project, we are conducting a rapid pragmatic trial in 6 health systems serving geographically and culturally diverse populations. With this supplement, we will address unanticipated challenges in real time to ensure that we complete the project as proposed, meeting enrollment targets and staying on our timeline. In Aim 1, we will bolster recruitment of Latino/Hispanic, Black/African American, and rural participants. In Aim 2 we will expand our clinical teams so they can manage high needs patients, carry larger caseloads, and deliver the medication care protocol with equity to all patients. In Aim 3, we will cover unanticipated expenses in accessing and managing electronic health record data. This work will pave the way for expanding access to high quality dementia care in the future, mitigating the negative impact of dementia on patients and their families across the nation.