Partners in Dementia Care (PDC)

Background: Partners in Dementia Care (PDC) is a care coordination and support service intervention for veterans with dementia and their family caregivers, delivered through partnerships between VA medical centers and local Alzheimer's Association Chapters. PDC was created from seven years of research and development, and was designed to be a feasible and practical intervention to integrate health, community, and support services. PDC has a standardized protocol for care coordination and support services, including guidelines for care plan assessment, care plan development and implementation, ongoing monitoring, and reassessment. It also offers a structured training curriculum for providers and an operations manual for uniform implementation.

Objectives: The primary objective of this investigation is to rigorously test the impact of PDC on a number of outcomes for veterans with dementia, family caregivers, and health care providers. Within VA Medical Centers, the focus will be on improving dementia care in primary care clinics, including geriatrics. Two specific research objectives and corresponding hypotheses will be addressed: 1. To test the impact of PDC on three categories of outcomes: psychosocial well-being outcomes (patient and caregiver effects); health care service use (patient effects only); and health care cost (patient effects only). HI:PDC, compared to usual care, will improve psychosocial well-being, including depression, health status, adequacy of care, and quality of care for patients with dementia and their caregivers. H2:PDC, compared to usual care, will reduce health care service use for patients with dementia, including hospital admissions, emergency department visits, nursing home admissions, and physician visits. H3:PDC is preferred to usual care based on cost-effectiveness and cost-benefit analyses. H4:The PDC intervention will be more effective in improving psychosocial well-being and reducing health care service use for patients and caregivers dealing with more severe patient impairment (e.g., cognitive status, functional status, and level of problem behaviors). 2. To evaluate the impact of PDC on role and intra-psychic strains caused by dementia and its care (patient and caregiver effects). H5a:PDC, compared to usual care, will decrease patient role and intra-psychic strain, including embarrassment about the illness, emotional strain, relationship strain, and social isolation. H5b:PDC, compared to usual care, will decrease caregiver role and intra-psychic strain, including role captivity, work care-related strain, relationship strain, emotional and physical health deterioration, and caregiving efficacy. H6:The PDC intervention will be more effective in decreasing role and intra-psychic strains for patients and caregivers dealing with more severe patient impairment (e.g., cognitive status, functional status, and level of problem behaviors). If effective, the long-term objective is to implement PDC in a regional, QUERI-like demonstration (Quality Enhancement Research Initiative), involving 30-40 VA medical centers. Additionally, the PDC approach will be adapted for other chronic conditions (e.g., heart disease, COPD, diabetes).

Methods: The proposed study is a 55-month, controlled trial of Partners in Dementia Care. The PDC intervention will be implemented in two intervention sites and three comparison sites that are matched on organizational, provider, and patient characteristics.

Findings: No findings at this time.