Improving Post-Diagnosis Dementia Care in Primary Care

改善初级保健中的痴呆症诊断后护理

基本信息

批准号：
9976006
负责人：
Halima Amjad
金额：
$ 19.82万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-05-15 至 2025-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/9976006
关键词：
Address Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Assessment tool Attitude Award Awareness Behavioral Symptoms Caregivers Caring Categories Clinic Clinical Clinical Investigator Clinical Practice Guideline Clinical Trials Code Cognition Community Physician Complex Computerized Medical Record Dementia Development Development Plans Diagnosis Disease Education Effectiveness of Interventions Elderly Ensure Environment Evaluation Event Family Family Caregiver Family health status Future Geriatrics Goals Guidelines Health Health system Improve Access Incentives Intervention Interview Knowledge Lead Link Maryland Medical Medicare Medicine Mentorship Methods Modeling Neurology Nurses Patient Care Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Population Prevention Primary Health Care Psychiatry Quality of Care Randomized Controlled Trials Recommendation Reimbursement Mechanisms Research Research Methodology Research Personnel Research Support Resources Role Safety Services Social Workers Structure Surveys System Testing Time Time Management Training Translating Translations Universities Visit care delivery care outcomes care providers career career development caregiving clinical care clinical investigation clinical practice cognitive testing comorbidity dementia care design effective intervention epidemiology study evidence base experience implementation science implementation strategy improved medical schools member multidisciplinary patient oriented research pragmatic trial preference primary care setting professor response skills support tools therapy development tool uptake

项目摘要

PROJECT SUMMARY Dr. Halima Amjad is an Assistant Professor of Medicine and practicing geriatrician with clinical expertise in Alzheimer's disease and related dementias at the Johns Hopkins University School of Medicine. Her long-term career goal is to become a leader in patient-oriented research that informs and improves medical care for older adults with dementia through the development and implementation of care delivery interventions in clinical practice. This award will ensure she has the knowledge, skills, and experience to develop effective interventions, lead clinical trials, and translate research findings into routine clinical care. The career development plan proposes five years of informal and formal training in mixed methods research, intervention development and testing including clinical trials, and implementation science focused on Alzheimer's disease and related dementias. Dr. Amjad has convened an outstanding mentorship team with expertise in the relevant research methods, dementia care, primary care, and care for complex older adults. The proposal will take place in a rich scientific environment with the resources necessary to support her research, career development, and transition to independent clinical investigation. Despite the growing burden of dementia on patients, families, and health systems, the majority of older adults with dementia receive suboptimal care for dementia after diagnosis. Clinical practice guidelines for dementia care are available, but are not widely known or consistently followed. Recent health systems changes, including new Medicare reimbursement mechanisms and uptake of electronic medical records (EMRs), present opportunities to improve post-diagnosis care for dementia in busy primary care settings. The proposal leverages these opportunities to address the complex challenges of clinical practice transformation and linking diagnosis to timely, high quality dementia care. Aims 1 and 2 use a mixed methods approach (primary care provider and multidisciplinary staff surveys and interviews, patient and family interviews) to understand barriers and facilitators to post-diagnosis dementia care, key stakeholder perspectives on essential components and strategies for dementia care, and perceived feasibility of a comprehensive, multidisciplinary post-diagnosis dementia care intervention. Results will inform the adaptation of an intervention centered around a structured post-diagnosis dementia care visit in primary care in Aim 3. Implementation will leverage EMRs and Medicare reimbursement for dementia care to bring dementia-related assessment and support tools to primary care. Feasibility and acceptability of the intervention will be tested in one primary care clinic, laying the groundwork for a future multisite pragmatic randomized controlled trial to assess intervention effectiveness in improving quality of care and patient outcomes. The proposal addresses a significant challenge (dementia care) in an important setting (primary care). It will lead to an intervention that can be widely implemented and a clinical investigator poised to transform medical care for persons living with dementia.

项目概要 Halima Amjad 博士是医学助理教授和临床老年病学家约翰·霍普金斯大学医学院在阿尔茨海默病和相关痴呆症方面的专业知识。她的长期职业目标是成为以患者为导向的研究领域的领导者，为患者提供信息并改进通过制定和实施护理服务，为患有痴呆症的老年人提供医疗护理临床实践中的干预。该奖项将确保她拥有知识、技能和经验制定有效的干预措施，领导临床试验，并将研究结果转化为常规临床护理。这职业发展计划提出五年的混合方法研究非正式和正式培训，干预措施的开发和测试，包括临床试验和实施科学，重点关注阿尔茨海默病和相关痴呆症。 Amjad 博士召集了一支优秀的导师团队相关研究方法、痴呆症护理、初级护理和复杂老年人护理方面的专业知识。该提案将在丰富的科学环境中进行，并有必要的资源来支持她研究、职业发展以及向独立临床研究的过渡。尽管痴呆症给患者、家庭和卫生系统带来的负担越来越大，但大多数老年人患有痴呆症的成年人在诊断后接受的痴呆症治疗效果不佳。临床实践指南痴呆症护理是可用的，但并未广为人知或得到一致遵循。最近的卫生系统变化，包括新的医疗保险报销机制和电子病历的采用（EMR），为在繁忙的初级保健机构中改善痴呆症诊断后护理提供了机会。这提案利用这些机会来应对临床实践转型的复杂挑战将诊断与及时、高质量的痴呆症护理联系起来。目标 1 和 2 使用混合方法（初级保健提供者和多学科工作人员调查和访谈、患者和家属访谈）了解诊断后痴呆症护理的障碍和促进因素，主要利益相关者对基本要素的看法痴呆症护理的组成部分和策略，以及综合、多学科的可行性诊断后痴呆症护理干预。结果将为以干预为中心的调整提供信息围绕目标 3 中初级保健中的结构化诊断后痴呆症护理就诊。实施将利用痴呆症护理的电子病历和医疗保险报销带来了与痴呆症相关的评估和支持工具到初级保健。干预措施的可行性和可接受性将在一家初级保健诊所进行测试，为未来评估干预效果的多中心实用随机对照试验奠定基础提高护理质量和患者治疗效果。该提案解决了一项重大挑战（痴呆症护理）在重要环境（初级护理）中。它将导致可广泛实施的干预措施和临床研究人员准备改变痴呆症患者的医疗保健。