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

Brent P. Forester, MD, MSc, 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.