Diagnosed prevalence of Alzheimer’s disease and related dementias in Medicare Advantage plans
July 5, 2020
Author: Sonya Sutton
Mor and colleagues in Washington Post OpEd: We can’t protect nursing homes from covid-19 without protecting everyone
IMPACT Collaboratory co-principal investigator Vincent Mor, PhD and colleagues authored an opinion piece on June 25 in the Washington Post describing how research studies have shown that the key issue in managing infection rates of the virus within nursing homes is the rate of infection in the surrounding community.
Mor and his colleagues David C. Grabowski, professor of health-care policy at Harvard Medical School and R. Tamara Konetzka is a professor of health services research at the University of Chicago shared that all three had independently analyzed what determines whether a nursing home will see a coronavirus outbreak. All three research teams found that community infection rates where the nursing home was located was most strongly associated with high infection rates within the facilities.
“No care facility, no matter how excellent, can keep covid-19 away if it’s widespread in the areas where staff members live and work. To protect our most vulnerable citizens, we have to protect everyone,” said the authors in the article.
Read the full opinion piece in the Washington Post at this link.
Covid-19 Among Older Persons in Health Care Systems: Pragmatic Responses to the Crisis
June 2020 – In this Special Grand Rounds, Drs. Lipsitz, Rudolph, and White discuss their ongoing projects to meet the unique challenges COVID-19 presents managing care of older persons.
Lewis Lipsitz, MD
Marcus Institute for Aging Research
Hebrew SeniorLife
James Rudolph, MD
Brown University
Elizabeth White, PhD, ARPN
Brown University
Learning Objectives
- Describe key ethical issues raised by pragmatic RCTs and which may be particularly salient to the ADRD context
- Describe the challenges of identifying a sample of pragmatic RCTs from the literature
- Describe the landscape of key ethical issues in published pragmatic RCTs in ADRD
Stakeholder Engagement in ePCTs for People Living with Dementia
May 2020 – In Grand Rounds 6, Ellen Tambor, MA from IMPACT's Engaging Partners Team presents on the special considerations for engaging stakeholders in ePCTs for AD/ADRD and provides an overview of plans for promoting meaningful stakeholder engagement in the IMPACT Collaboratory.
Learning Objectives
- Describe the rationale for stakeholder engagement in research and the importance of engaging stakeholders in ePCTs
- Understand special considerations for engaging stakeholders in ePCTS for AD/ADRD.
- Describe plans for promoting robust stakeholder engagement throughout the IMPACT Collaboratory.
Brent Forester, MD, MSc
McLean Hospital, Mass General Brigham
Implementation of the Care Ecosystem training model for individuals with dementia in a high risk, integrated care management program
Health Care Systems
Mass General Brigham
Dr. Forester is the chief of the Center of Excellence in Geriatric Psychiatry at McLean Hospital and medical director for Behavioral Health and Evaluation and Research at Population Health Management at Mass General Brigham. He is an expert in geriatric psychiatry, specializing in the treatment of older adults with depression, bipolar disorder, and behavioral complications of Alzheimer’s disease and related dementias. Dr. Forester is Co-President of the American Association for Geriatric Psychiatry (AAGP), a distinguished fellow of the American Psychiatric Association and has previously served on boards of the AAGP and the Alzheimer’s Association of Massachusetts/New Hampshire. His research focuses on novel treatment approaches to manage the disabling behavioral complications of dementia, such as agitation and aggression. Dr. Forester’s work also includes studies using brain imaging techniques and careful clinical assessment to better understand the causes of depression and bipolar disorder in later life and to identify promising new targets for effective treatments.
RATIONALE:There is growing need for to provide high quality care for persons living with dementia (PLWD) and provide support for care partners in the primary care setting. The Care Ecosystem model is a telephone-based dementia care program that provides standardized, proactive, personalized, and scalable support and education for care partners. The Care Ecosystem model has demonstrated an improvement in patient quality of life, reduced unnecessary healthcare expenditures, and a decrease in care partner burden and depression.
OBJECTIVE:To assess the feasibility of implementing and measuring outcomes of an adapted Care Ecosystem training model for primary care nurse managers serving a diverse panel of PLWD and their caregivers in a large healthcare system.
SETTING:Primary care practices participating in the Mass General Brigham healthcare system’s Integrated Care Management Program in Boston, MA.
POPULATION:People with dementia and their care partners.
INTERVENTION:The intervention involves an adaptation of the Care Ecosystem model which trains primary care nurse case managers to deliver telephone-based collaborative dementia care. Nurse care managers will be randomly assigned to early versus delayed Care Ecosystem training (15 per group).
OUTCOMES: Leveraging the Mass General Brigham electronic medical record, the pilot study will establish the feasibility of collecting the primary clinical outcome defined as emergency department visits among the PLWD cared for by the primary care practices. Secondary outcomes will assess the feasibility of implementation, number of contacts between nurse care managers and care partners, and documented advance care planning.
IMPACT: This pilot study will inform and strengthen the design of a large-scale implementation of an embedded pragmatic trial using a multi-site infrastructure offered through multiple service organizations within a large healthcare system. A scalable Care Ecosystem model of telephone-based collaborative dementia care delivered by primary care nurse managers has the potential to reduce unnecessary health care use while improving quality of care for patients with dementia.
COVID-19 in Nursing Homes: Pragmatic Research Responses to the Crisis
May 2020 – In this Special Grand Rounds, Drs. Grabowski, Mitchell, and Mor, experts in dementia care and pragmatic clinical trials, provide an update on how COVID-19 is impacting nursing homes and to share preliminary data for research related to COVID-19.
Professor of Health Care Policy
Department of Health Care Policy, Harvard Medical School
Principal Investigator, Administration & Management Core (AC)
Member, Steering Committee
Senior Scientist, Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research
Professor of Medicine, Harvard Medical School
Faculty, Division of Geriatrics, Beth Israel Deaconess Medical Center
Learning Objectives
- Learn about impact of COVID-19 in U.S nursing homes
- Gain knowledge about rapid pragmatic research approaches in response to the crisis in health care systems
• Hebrew SeniorLife
• Genesis Health Care
• Bluestone
Podcast
New NIH Health Care Systems Research Collaboratory summary covers statistical issues in ePCTs
The NIH Health Care Systems Research Collaboratory recently released a summary of a 2019 comprehensive workshop to explore and discuss statistical issues encountered with embedded pragmatic clinical trials (ePCTs). The new Workshop Summary describes panel discussions with the principal investigators and statisticians of NIH Collaboratory Demonstration Projects and the challenges and solutions encountered during the design and analysis of their trials.
Read more about the workshop and access the full summary on the NIH Collaboratory website.
Health equity as foundational to the design of pragmatic trials
April 2020 – In Grand Rounds 5, Drs. Quiñones and Jackson discuss health equity issues have not yet been fully considered, assessed, or integrated into ePCT designs. Health disparities populations may not be well represented in ePCTs without special efforts to identify and successfully recruit sites of care that serve larger numbers of these populations.
Learning Objectives
- Understand the role and objectives of the Health Equity Team in the IMPACT Collaboratory.
- Describe the conceptualization of health equity as it relates to ePCTs design.
- Understand and describe important health equity considerations in the design of ePCTs.
AcademyHealth report identifies health systems’ priority research questions on COVID-19
AcademyHealth has developed a report focused on information needs of the health care and community organizations engaged in the COVID-19 response. The report is intended to inform decision-making of federal and foundation funders of health services research to guide investments in responsive research.
Read the full report and background information on the AcademyHealth website.
IMPACT members participate in national virtual workshop on systematic review
On April 15 2020, the National Academies’ Committee on Care Interventions for Individuals with Dementia and Their Caregivers hosted a virtual public workshop. This workshop brought together key stakeholders and experts to provide input to the committee on a draft Agency for Healthcare Research and Quality (AHRQ) systematic review that examines existing evidence on care interventions that support individuals with dementia and their caregivers. This AHRQ systematic review will form the predominant basis of the National Academies committee’s report on which care interventions can be considered ready for broad implementation and dissemination.
IMPACT Collaboratory members Eric Larson, MD, MPH, Chris Callahan, MD, MACP, Jason Karlawish, MD, Maria Aranda, PhD, Laura Gitlin, PhD, FGSA, FAAN, and Joe Gaugler, PhD all participated in the workshop to provide input on the systematic review.
Read the full workshop agenda and participants on the workshop summary website.