Dissemination of a successful dementia care program: Lessons to facilitate spread of innovations

Abstract

Background: Despite the effectiveness of innovations to improve the care of persons with dementia, there has been limited diffusion of these into widespread clinical practice. We aimed to identify common barriers and address them directly in the initial phase of dissemination of a successful dementia care program.Methods: Description of and early experience with a dissemination strategy of the UCLA Alzheimer's and Dementia Care Program to health care systems nationwide. We measured site-identified goals for the program and indicators of success, number of adopting sites, and participants in their programs. Results: From January 2019 to December 2021, 80 sites expressed interest in adopting the program, 14 (18%) sites adopted it, and 10 of these sites have begun caring for patients. Another 4 sites have implemented the program as part of a randomized clinical trial. To date, over 1690 persons living with dementia and their caregivers have received Alzheimer's and Dementia Care (ADC) care at 14 adopting sites. Key lessons from the early dissemination efforts include the importance of identifying a strong product champion at the adopting site, creating a business case for adoption, training of clinical staff and adapting the model to fit local cultures and workflow, as well as recognizing the likely long length of time needed for the decision to adopt and implementation process.Conclusions: Despite many obstacles to dissemination, with local champions and technical assistance, successful innovations in dementia care can be implemented in diverse health systems. The ability to adopt sites to bring the program to full scale and achieve comparable outcomes to the original program remains to be determined.

Living With Dementia: Care Partner Needs and Outcomes of a Dementia Support Program in Primary Care

“…Finally, CTNs are trained and supported to provide dementia support and education and do not require formal licensure which allowed for recruitment from a diverse applicant pool of potential CTNs. For these reasons, LWD appears to be feasible for the primary care setting, especially in the context of value-based payment programs or reimbursement for chronic care management ( Reuben et al, 2022 ).…”

“…Although there is a clear need for improved access to collaborative care interventions for managing dementia and supporting care partner needs in primary care ( De Vreese et al, 2016 ; Larson & Stroud, 2021 ; Olivari et al, 2020 ), real-world implementation of such programs has been slow due to site and healthcare system barriers (e.g., stakeholder buy-in, training, and payment models) ( Possin et al, 2019 ; Reuben et al, 2022 ). These barriers to care provision may lead to unmet needs for dyads as they navigate a challenging and complicated healthcare system ( Mitchell et al, 2020 ).…”

Dissemination of a successful dementia care program: Lessons from early adopters

“…The adaptations described in this section illustrate implementation strategies that included slight deviations from the original model but still maintained fidelity to the core elements of the model (DCS role staffed by an advanced practice provider, staffing a dementia care assistant to help with administrative duties, provision of longitudinal dementia care, 24/7 coverage, access to electronic health records for efficient care coordination, and linkages to communitybased services). 7 At some institutions, the concept of co-management with an advanced practice provider proved complicated and sites needed to modify protocols based on feedback from primary care. For example, the original ADC Program as implemented at UCLA requires that patients have an established dementia diagnosis to enroll in the program.…”

A framework for addressing Alzheimer's disease: Without a frame, the work has no aim

“…routine clinical practice will bring numerous additional challenges as others have recently noted. [1][2][3] As challenging as this is at present, the number of people globally with dementia is projected to increase from 57.4 million in 2019 to 152.8 million in 2050, driven largely by population growth and population aging. 4 A "longevity revolution" is being driven not only by more individuals with ADRD, but also increased duration of disability and higher costs of care.…”