Implementing innovative models of dementia care: The Healthy Aging Brain Center

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Abstract:

Background: Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers. Objective: To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis. Methods: We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). Results: Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (standard deviation, SD 9.5), 40% were African-Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day rehospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs. Conclusion: The tools of 'implementation science' can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.

Keywords: complex adaptive system; dementia care; implementation science; informal caregiver; memory care practice

Document Type: Research Article

DOI: http://dx.doi.org/10.1080/13607863.2010.496445

Affiliations: 1: Indiana University Center for Aging Research, Indianapolis, USA,Regenstrief Institute, Inc., Indianapolis, IN, USA,Wishard Health Services, Indianapolis, IN, USA 2: Indiana University Center for Aging Research, Indianapolis, USA,Regenstrief Institute, Inc., Indianapolis, IN, USA 3: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA 4: Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana Alzheimer Disease Center, Indianapolis, IN, USA 5: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA,Indiana Alzheimer Disease Center, Indianapolis, IN, USA 6: Indiana University Center for Aging Research, Indianapolis, USA,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA,Regenstrief Institute, Inc., Indianapolis, IN, USA

Publication date: January 1, 2011

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