Grand Rounds 14- March 2021

Update on Two IMPACT Funded Pilot Studies

March 2021 – In Grand Rounds 15, Drs. Forester and Hwang share experiences as Pilot Cycle 1 awardees and provide updates to their funded pilot studies.

Brent P. Forester, MD, MSc on his pilot: Implementation of the Care Ecosystem training model for individuals with dementia in a high risk, integrated care management program

Ula Hwang, MD, MPH on her pilot: Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department

Speakers

Brent P. Forester, MD, MSc

Brent P. Forester, MD, MSc
Chief, Center of Excellence in Geriatric Psychiatry, McLean Hospital Medical
Director, Behavioral Health Integration, Quality, and Patient Experience, Mass General Brigham

Ula Hwang, MD, MPH

Ula Hwang, MD, MPH
Professor, Vice Chair for Research, Department of Emergency Medicine
Yale School of Medicine

Learning Objectives

Dr. Forester:

  • To understand the rationale and design of our adaptation of the Care Ecosystem model to train nurse case managers to deliver telephone-based collaborative dementia care.
  • To appreciate the successes and challenges encountered in stakeholder engagement, adaptation of the Care Ecosystem training program and implementation of the model.
  • To describe updates on pilot progress to date and plans for a larger embedded pragmatic clinical trial.

Dr. Hwang:

  • To describe the Pathway to Detection & Differentiation of Delirium & Dementia in the Emergency Department (PD4ED) pilot.
  • To share challenges and solutions of implementation with an embedded pragmatic trial (during a pandemic and institution move).
  • To provide updates on the status of the PD4ED pilot study implementation.

 

Podcast 14: Ethical challenges with pragmatic RCTs: General issues and special considerations in dementia

link to brody profileStuart Nicholls, PhD, from the Clinical Epidemiology Program at the Ottawa Hospital Research Institute, continues the discussion from his February 18 Grand Rounds presentation. This discussion with IMPACT Principal Investigator Susan Mitchell, MD, MPH answers questions from Dr. Nicholls's presentation on giving an overview of ethical issues raised by pragmatic randomized controlled trials (RCTs) and which derive from ongoing work to develop guidance for those designing and conducting pragmatic RCTs.

 

 

Want to hear more? View the full Grand Rounds presentation.

For alerts about new episodes, subscribe free on iTunes or SoundCloud.

Ethical challenges with pragmatic RCTs: General issues and special considerations in dementia

February 2021 – In Grand Rounds 14, Dr. Nicholls provides an overview of ethical issues raised by pragmatic randomized controlled trials (RCTs), outlines challenges in conducting empirical studies of the published literature, and provides preliminary data on the reporting of key ethical issues in published pragmatic RCTs in AD/ADRD.

Speaker

Stuart G. Nicholls, PhD

Stuart G. Nicholls, PhD
Ottawa Health Research Institute

Watch the Webinar

Webinar Slides

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

Implementation in ongoing ADRD ePCTS in different health care settings using real examples

January 2021 – Ground Rounds 13, features Drs. Brody, McCreedy, and Colburn providing examples of ongoing implementation of ePCTs within health care systems for people with AD/ADRD followed by a response from Dr. Mittman, a prominent scientist with expertise in implementation of complex interventions in health care systems.

Webinar Slides

Webinar Recording

Ab Brody, PhD, RN, FAAN

Ab Brody, PhD, RN, FAAN

Core Leader, Pilot Studies Core
Member, Steering Committee

Associate Professor of Nursing and Medicine, New York University Rory Meyers College of Nursing
Associate Director, Hartford Institute for Geriatric Nursing
Founder, Aliviado Health

Ellen McCreedy, PhD, MPH

Ellen McCreedy, PhD, MPH

Executive Committee, Technical Data Core

Assistant Professor, Brown University School of Public Health

Jessica Colburn, MD

Jessica Colburn, MD

Johns Hopkins University School of Medicine

Implementation Workgroup Lead

 

Learning Objectives

  • Understand the implementation strategies used in 3 pragmatic clinical trials among persons living with dementia
  • Gain knowledge about implementation barriers and facilitators of complex interventions in pragmatic trials
  • Apply a novel framework to promote complex health intervention implementation in health care systems

 

Grand Rounds 12- December 2020

Improving Serious Illness Care Through Large Pragmatic Trials

December 2020 – In Grand Rounds 12, Dr. Halpern discusses improving care through large pragmatic trials. Dr. Halpern reviews explanatory trials in serious illness care, informed consent, and many other approaches of pragmatic clinical trials to improve the palliative care for seriously ill, hospitalized patients.

Webinar Slides

Speaker

Scott Halpern, MD, PhD

Scott Halpern, MD, PhD

Member, Steering Committee

Professor of Medicine, Epidemiology, and Medical Ethics and Health Policy,
University of Pennsylvania

Webinar Recording

Learning Objectives

  • Participants will understand the importance of improving serious illness care and how it can be done through large pragmatic trials
  • Participants will understand the use of explanatory trials in serious illness care
  • Participants will understand how pragmatic trials can improve palliative care for hospitalized patients
Grand Rounds 11 November 2020

Implementation Outcomes: Their Role in Treatment Success

November 2020 – In Grand Rounds 11, Dr. Proctor presents on the role of implementation outcomes in implementation science, the current state of knowledge, conceptual and methodological challenges they pose, and directions for research to clarify how to effectively achieve implementation outcomes, understand their dynamic relationships to one another, and capture their effects in treatment effectiveness and public health impact.

Speaker

Enola Proctor, PhD

Enola Proctor, PhD

Professor
Brown School, Washington University in St. Louis

Learning Objectives

  • Participants will understand the importance of implementation outcomes
  • Participants will understand the conceptual and methodological challenge for studying implementation outcomes
  • Participants will know priorities for future research on implementation outcomes
Grand Rounds 10 - October 2020

The AHRQ and Lancet Reports on Dementia Interventions: Interpretation and Implications for Embedded Pragmatic Trials

October 2020 – In Grand Rounds 10, Members of the IMPACT Health Care Systems Core and Implementation Core summarize the AHRQ and Lancet Reports on Dementia Interventions and their implications for pragmatic trials, with commentary from NIA representative Lis Nielsen, PhD, Director of the Division of Behavioral and Social Research (DBSR).

Download webinar slides.

Joe Gaugler, PhD

Joe Gaugler, PhD

Associate Core Leader, Implementation Core

Robert L. Kane Endowed Chair in Long-Term Care and Aging, Professor, University of Minnesota

Eric Larson, MD, MPH

Eric Larson, MD, MPH

Core Leader, Health Care Systems (HCS) Core
Member, Steering Committee

Vice President, Research and Health Care Innovation, Kaiser Foundation Health Plan of Washington
Executive Director and Senior Investigator, Kaiser Washington Health Research Institute

Lis Nielsen, PhD 

Lis Nielsen, PhD 

Director, Division of Behavioral and Social Research, National Institute on Aging

Grand Rounds September 2020

Not all approaches to data are equal: Data-related challenges for pragmatic trials involving PLWD

September 2020 – In Grand Rounds 9, Members of IMPACT's Technical Data Core (TDC) discuss how data algorithms from electronic health records (EHRs) are used to identify, characterize and capture relevant health outcomes of people living with dementia (PLWD) and their care partners.

Download webinar slides.

 

Speakers

David Dorr, MD, MS

David Dorr, MD, MS

Executive Committee, Technical Data Core
Professor and Vice Chair of Medical Informatics and Clinical Epidemiology
Professor of Medicine, Division of General Internal Medicine and Geriatrics
Chief Research Information Officer, Biomedical Informatics Graduate Program, Oregon Health & Science University School of Medicine

V.G. Vinod Vydiswaran, PhD

V.G. Vinod Vydiswaran, PhD

Executive Committee, Technical Data Core
Assistant Professor of Learning Health Sciences, University of Michigan

Learning Objectives

  • Understand key data-related steps involved in designing pragmatic trials and trade-offs
  • Identify data-driven approaches to identify people living with dementia and caregivers - focus on EHR
  • Identify challenges in validating approaches in different healthcare settings
Grand Rounds July 2020

Breaking the Cycle: Health Care Systems Interactions for Impactful Results

July 2020 – Grand Rounds 8, Members of the IMPACT Health Care Systems Core share how embedded pragmatic trials can benefit both health care systems and the research community.

Download webinar slides.

Eric Larson, MD, MPHEric Larson, MD, MPH

Core Leader, Health Care Systems Core
Member, Steering Committee

Vice President, Research and Health Care Innovation, Kaiser Foundation Health Plan of Washington
Executive Director and Senior Investigator, Kaiser Washington Health Research Institute

Leah Hanson, PhD

Leah Hanson, PhD

Associate Core Leader, Health Care Systems Core

Senior Research Investigator, Senior Director of Research at HealthPartners Neuroscience Center, HealthPartners Institute
Co-Director of Research, HealthPartners Center for Memory & Aging

Jeff Williamson, MD, MHS

Jeff Williamson, MD, MHS

Executive Committee, Health Care Systems (HCS) Core
Steering Committee Member

Professor, Chief of Geriatric Medicine, and Director for Center for Healthcare Innovation, Wake Forest School of Medicine

David Reuben, MD

David Reuben, MD

Executive Committee, Health Care Systems (HCS) Core

Archstone Professor of Medicine, Director, UCLA Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA

Learning Objectives

  • Communicate the need and promise for improvement of dementia care with embedded pragmatic trials within dynamic health care settings.
  • Review what we have found to be key components of ePCT trial design and conduct for ensuring that study results are implementable.
  • Provide learnings of two ePCT trialists from The Dementia Care Study: A Pragmatic Clinical Trial of Health System-Based Versus Community-Based Dementia Care (D-CARE)

 

Finding Pragmatic and Relevant Outcomes for AD/ADRD ePCTs

June 2020 – Grand Rounds 7, members of IMPACT's Patient Caregiver Relevant Outcomes Core describe person and caregiver-centered outcome measurement in AD/ADRD ePCTs, give an overview of how outcomes are mapped to care domains, and highlight the methodological challenges present in AD/ADRD and pragmatic research.

Download Webinar Slides

Speakers

Laura C. Hanson, MD, MPHLaura C. Hanson, MD, MPH
Core Leader, Patient/Caregiver Relevant Outcomes Core
Member, Steering Committee

Professor, Division of Geriatric Medicine
Director, UNC Palliative Care Program
University of North Carolina School of Medicine

Sheryl Zimmerman, PhDSheryl Zimmerman, PhD
Executive Committee, Patient/Caregiver Relevant Outcomes (PCRO) Core

University Distinguished Professor and Co-Director, Program on Aging, Disability, and Long-Term Care, Cecil G. Sheps Center for Health Services Research
University of North Carolina at Chapel Hill

Learning Objectives

  • Describe outcomes relevant for people living with dementia and their caregivers
  • Describe the application of the Alzheimer’s Association conceptual framework to link care interventions to outcomes
  • Describe considerations for selecting outcome measures for AD/ADRD ePCTs