Graphic with headshots of Drs. McCreedy, Sadarangani, and Zimmerman from the shoulders up, next to the words "Grand Rounds & Podcast. January 2024"

Strategies to Implement ePCTs in Home and Community-Based Settings – Issues and Successes in Assisted Living and Adult Day Centers

January 2024 – In Grand Rounds 43, Drs. McCreedy, Sadarangani, and Zimmerman note common challenges that arise when conducting ePCTs in home and community-based, long-term care settings and suitable solutions to address these challenges.

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Ellen McCreedy, PhD

Assistant Professor

Brown University School of Public Health

 

Tina Sadarangani,
PhD, RN

Associate Professor

NYU Rory Meyers College of Nursing

Sheryl Zimmerman, PhD

University Distinguished Professor

University of North Carolina at Chapel Hill

Learning Objectives

  • Understand the national scope of assisted living and adult day centers (i.e., home and community-based settings)
  • Recognize common challenges conducting ePCTs in home and community-based settings
  • Be familiar with strategies to address challenges conducting ePCTs in home and community-based settings
Graphic with headshots of Drs. O'Brien and Fowler from the shoulders up, next to the words "Grand Rounds & Podcast. December 2023"

The Clinical Implementation of Alzheimer’s Disease Biomarkers

December 2023 – In Grand Rounds 42, Drs. O'Brien and Fowler engage in a discussion regarding the landscape of Alzheimer's disease (AD) biomarker testing, dive into the potential clinical usefulness of plasma AD biomarkers, and identify the obstacles that hinder the implementation of plasma AD biomarkers.

Speakers


Kyra S. O'Brien, MD

Assistant Professor of Neurology

Penn Memory Center, University of Pennsylvania


Nicole Fowler, PhD, MHSA

Associate Professor of Medicine

Indiana University School of Medicine

Learning Objectives

  • Understand the landscape of Alzheimer’s disease (AD) biomarker testing.
  • Describe the potential clinical utility of plasma AD biomarkers.
  • Identify barriers to plasma AD biomarker implementation in specialist and non-specialist settings.

 

Graphic with a headshot of Dr. Michael Harhay from the shoulders up, next to the words "Grand Rounds & Podcast. November 2023"

Outcomes truncated by death in randomized trials

November 2023 - In Grand Rounds 41, Dr. Harhay addresses the impact of intercurrent events, specifically the occurrence of death in patients with critical illness during research studies, which can lead to missing outcome data and potentially biased results. Dr. Harhay discusses various approaches, such as composite outcomes, to navigate complexities of this missing data issue.

Speaker

Michael Harhay, PhD, MPH

Assistant Professor of Epidemiology and Medicine (Pulmonary and Critical Care)

University of Pennsylvania

Learning Objectives

  • Articulate the risks of bias associated with having outcomes truncated by death in randomized trials.
  • Assess options to address outcomes truncated by death using the estimand framework.
  • Understand tradeoffs between approaches such as statistical models and composite outcome to address outcomes truncated by death.

 

Graphic with a headshot of Dr. Katherine (Katie) Courtright from the shoulders up, next to the words "Grand Rounds & Podcast. October 2023"

Electronic Nudges and Pragmatic Trials to Improve Hospital Palliative Care Delivery

October 2023 - In Grand Rounds 40, Dr. Courtright shares the integration of systematic referral criteria ("triggers") with behavioral insights to nudge clinicians, offering a low-cost, scalable, and powerful approach to promote palliative care delivery.

Speaker

Katherine Courtright, MD, MSHP

Assistant Professor of Medicine
Palliative and Advanced Illness Research (PAIR)

Perelman School of Medicine, University of Pennsylvania

Learning Objectives

  • Consider ways to leverage technology within a learning health system to improve palliative care delivery.
  • Describe choice architecture and tradeoffs with different types of behavioral nudges.
  • Anticipate implementation challenges and opportunities for nudges to improve inpatient palliative care delivery.

 

Graphic with a headshot of Dr. James Flory from the shoulders up, next to the words "Grand Rounds & Podcast. September 2023"

Decision Architecture Randomization Trials: Extremely Low-Cost Trials with Preservation of Clinician and Patient Choice

September 2023 – In Grand Rounds 39, Dr. Flory introduces an innovative trial design known as Decision Architecture Randomization Trials (DART), which aims to utilize the 'decision architecture' of electronic health records to incorporate randomized nudges into various prescribing decisions.

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Speaker

 

James Flory, MD, MSCE

Assistant Attending Physician

Endocrinology Service

Memorial Sloan Kettering Cancer Center

Learning Objectives

  • Define ‘nudges’, ‘decision architecture’, and ‘A/B testing’.
  • Describe a decision architecture randomization trial (DART).
  • Understand how DART relates to other pragmatic clinical trial designs.

 

Mission Moment: Marie M. Desir, Senior Patient Care Associate (PCA) at Hebrew SeniorLife

Marie M. Desir, Senior Patient Care Associate (PCA) at Hebrew SeniorLife provided this year’s mission moment for the IMPACT Collaboratory Annual Steering Committee & Business Planning Meeting, held on April 11, 2023.

Ms. Desir shared her unique experience as a frontline member of the healthcare team working with people living with dementia during the COVID-19 pandemic.

Ms. Desir provided a heartfelt description of the challenges that providers, patients, and families faced throughout the pandemic. She provided examples of how her team maintained their humor and humanity to overcome obstacles to good caregiving. Her account received a standing ovation for her inspiring mission moment.

Patient and Caregiver Relevant Outcomes

Patient and Caregiver Relevant Outcomes

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Tip Sheet

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Resources

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Other Suggested Training Modules

Phasellus vehicula magna sit amet dui pulvinar vulputate. Cras viverra faucibus metus, sit amet eleifend neque sodales aliquet. Pellentesque tempus lectus urna, nec rutrum nunc euismod quis. Quisque pretium id est nec imperdiet. Duis vel malesuada risus, at rutrum diam. Nullam nec massa a orci blandit ultricies non id eros. Aenean rhoncus elit ut mi accumsan tincidunt. Pellentesque in eros fermentum, efficitur neque non, ullamcorper quam. Donec maximus enim eget arcu pulvinar elementum. Aliquam et auctor massa. Aenean et turpis dictum, varius tortor in, fringilla risus. Nulla non ligula dapibus, placerat nulla vel, hendrerit risus. Donec vel tortor turpis. In felis magna, pretium id varius non, euismod sit amet felis.

Mission Moment: Louise Phillips, MD

link to videoThe mission of the NIA IMPACT Collaboratory is to build the nation’s capacity to conduct pragmatic clinical trials of interventions embedded within health care systems for people living with dementia and their care partners.   Our Mission Moments highlight the perspective of someone directly involved with dementia to remind us of the importance of our mission. In this Mission Moment, Louise Phillips, MD shares her experience as a person living with dementia and a retired physician.

 

 

 

Ula Hwang, MD, MPH

Yale School of Medicine

Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Health Care Systems

Yale School of Medicine
Northwestern University

Dr. Hwang is a professor of emergency medicine and geriatrics and palliative medicine at the Yale School of Medicine. Her research interests are understanding and improving quality of care for older adults in the emergency department (ED). Dr. Hwang authored the paper “The Geriatric Emergency Department,” the basis of the CMS Health Care Innovation Award program, GEDI WISE (Geriatric ED Innovations in care through Workforce, Informatics, and Structural Enhancements). Her leadership and committee positions involve national efforts to improve care for older adults in the ED. She is Co-PI on the Geriatric Emergency Department Collaborative (GEDC) funded by the John A. Hartford Foundation and Gary and Mary West Health Institute, and PI for the Geriatric Emergency care Applied Research (GEAR) Network, a NIA funded R21/R33. Dr. Hwang’s projects have evaluated the impact on patient outcomes of Geriatric ED interventions, improving emergency provider practices in medication prescribing for older adults, analgesic safety and effectiveness, and ED quality of care with support by the NIA, Veterans Affairs, Health Services Research & Development, and foundations.

RATIONALE: Vulnerable older adults often seek care in emergency departments (EDs). Although assessment for dementia is not traditionally performed in the ED, detection and recognition of unidentified Alzheimer’s disease and related dementias at this point of contact may provide a pathway for improved care delivery and outcomes in this population.

OBJECTIVE: To pilot test and establish the feasibility of a conducting a pragmatic clinical trial to test an effectiveness intervention that embeds cognitive impairment screening into the routine care of older patients in the ED setting and refers those identified as needing formal cognitive evaluation for outpatient assessment.

SETTING: Two academic health care systems in Chicago and New York City, their EDs and outpatient Geriatrics clinic and outpatient Neuropsychiatry clinics.

POPULATION: Community-dwelling patients age over 65, discharged from the ED.

INTERVENTION: The intervention will be embedded into the clinical flow of the ED and consists of:  1. routinized cognitive assessment of subjects by ED clinicians, and when appropriate, 2. referral of older patients with unrecognized cognitive impairment and dementia (UCID) for formal outpatient cognitive evaluation within the health care system network.

OUTCOMES: By leveraging the electronic medical records in the two health care systems, the pilot study will establish the feasibility of collecting the primary clinical outcome defined as the rate of referred ED patients who complete an outpatient cognitive evaluation. Secondary outcomes will include measures of feasibility of subject enrollment, validation of ED cognitive assessment, acceptability of the workflow among ED providers, and disposition of targeted subjects after ED evaluation.

IMPACT: This pilot study will inform and strengthen the design of a large-scale, multicenter embedded pragmatic trial implemented in the Geriatric Emergency Department Collaborative network of hospitals.  Effective cognitive screening and referral from the ED setting could improve detection and subsequent community-based care and assistance with treatment planning for patients with unrecognized cognitive impairment and dementia.

Laura Gitlin quoted in New York Times article for new therapies for people living with dementia

Laura Gitlin
Laura Gitlin, PhD, FGSA, FAAN

Laura Gitlin, PhD, FGSA, FAAN, leader of the NIA IMPACT Collaboratory Implementation Core, was quoted in the December 8th edition of the New York Times addressing the need for meaningful activities as part of treatment for people living with dementia. Gitlin and her colleagues at the College of Nursing and Health Professions at Drexel University have developed the Tailored Activity Program, which identifies activities that are meaningful to people with dementia, and adapts the activity to the patient’s abilities to make them a regular part of their day.

“Boredom and having nothing to do contributes to having an array of behavioral symptoms, agitation, aggressiveness, apathy, rejection of care,” she said.

Read the full article at this link.