Harvard Medical School; Harvard Pilgrim Health Care Institute
Collaborative Care Coordination Program for Alzheimer’s Disease and Related Dementias (Co-CARE-AD)
Health Care Systems
Tufts Health Plan
Dr. Li is an instructor in the Harvard Medical School Department of Population Medicine and the Harvard Pilgrim Health Care Institute. Her research interest is in generating valid and actionable evidence regarding the uses, benefits, and harms of treatments from real-world data to inform clinical decisions and healthcare delivery. Dr. Li has expertise in large electronic healthcare databases, advanced pharmacoepidemiologic and causal inference methods, and comparative effectiveness research. She has training and extensive experience in the use of high-dimensional electronic health data, including administrative claims and electronic health records, to assess effects of complex treatments. Dr. Li has developed an innovative research program in Alzheimer’s disease and related dementias (ADRD), leveraging her expertise in pharmacoepidemiology and causal inference. She is PI of an NIA-funded project to optimize the use of symptomatic dementia drugs in persons living with ADRD. She also participates in an NIA-funded pilot study for a pragmatic randomized trial, embedded in health insurers, to assess an education intervention for inappropriate prescribing in ADRD.
Dr. Platt is professor and chair of the Harvard Medical School Department of Population Medicine, and president of the Harvard Pilgrim Health Care Institute. He has extensive experience in developing systems and capabilities for using routinely collected electronic health information to support public health surveillance, medical product safety assessments, comparative effectiveness and outcomes research, and quality improvement programs. Dr. Platt has led health system-based intervention studies and observational studies using electronic medical record and claims data. He leads and participates in individual and cluster randomized trials embedded in health plans and large hospital networks. Dr. Platt is PI of the FDA’s Sentinel program, which performs post-marketing safety surveillance using the electronic health data from over 125 million people. He co-leads the coordinating centers of the NIH Health Care System Research Collaboratory; PCORnet, PCORI's National Patient Centered Clinical Research Network; and a CDC Prevention Epicenter. He is a member of the NAM Leadership Consortium for a Value and Science Driven Learning Health System, and the Association of American Medical Colleges Advisory Panel on Research.
RATIONALE: Collaborative care programs that use multidisciplinary teams to provide multicomponent care coordination and support can benefit individuals with Alzheimer’s disease and related dementias (ADRD) and their caregivers across all disease stages. The effectiveness of these programs when embedded in health insurers or their Medicare Advantage plans has not been rigorously evaluated.
OBJECTIVE: To conduct a randomized, pragmatic clinical trial to evaluate the effectiveness of a collaborative care-coordination program embedded in a health plan for people living with ADRD and their care partners versus usual care.
SETTING: Tufts Health Plan in New England.
POPULATION: Community-dwelling Medicare Advantage members living with ADRD and their care partners.
INTERVENTION: The Dementia Care Consultation (DCC) program, delivered by a care consultant over a 6-month period, provides an in-depth, personalized service for individuals and families facing ADRD. The program consists of comprehensive needs assessments, creation and implementation of personalized care plans, monitoring and revising care plans, disease education and support coaching, referrals to community-based organizations for service and support, and access to assistance.
OUTCOMES: We will assess healthcare utilization outcomes of people with ADRD over 6 and 12 months of follow-up. The primary outcome is emergency department visits. Secondary outcomes include outpatient visits, avoidable emergency department visits, and admission to long-term care facilities. We will also evaluate the implementation and program costs.
IMPACT: This Demonstration Project will generate evidence on the effectiveness of a comprehensive dementia care-coordination program that can be efficiently implemented at scale in health insurers and their Medicare Advantage plans, which will open a new avenue for providing support to large segments of the individuals and families affected by ADRD.