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Enhancing Care for Older Adults with Acute & Chronic CI

Enhancing Care for Older Adults with Acute & Chronic CI. Malaz Boustani, MD, MPH Chief Research Officer, Indianapolis Discovery Network for Dementia Geriatrician, Clarian Health Senior Center Assistant Professor of Medicine, IU School of Medicine Scientist, Regenstrief Institute, Inc

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Enhancing Care for Older Adults with Acute & Chronic CI

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  1. Enhancing Care for Older Adults with Acute & Chronic CI Malaz Boustani, MD, MPH Chief Research Officer, Indianapolis Discovery Network for Dementia Geriatrician, Clarian Health Senior Center Assistant Professor of Medicine, IU School of Medicine Scientist, Regenstrief Institute, Inc Beeson Scholar, National Institute on Aging www.indydiscoverynetwork.com

  2. Cognitive Impairment? • Any level of acute or chronic deficit in the brain cognitive function • Acute: • Delirium (46%) • Chronic: • Dementia (AD, VaD, LBD) (26%) • Mild Cognitive Impairment (MCI) (28%) www.indydiscoverynetwork.com

  3. Dementia in IN: 2000 – 2010 www.indydiscoverynetwork.com Boustani et al, JGIM, 2005; Alzheimer Disease Facts and Figures, 2007

  4. Dementia Caregivers in IN • Total Number in 2005 • 208,817 • Hours of unpaid care per year • 180,250,419 • Total value of unpaid care • $1,762,849,095 Alzheimer Disease Facts and Figures, 2007 www.indydiscoverynetwork.com

  5. CI Burden in Central IN Hospitals 1995- 1999 • 40% of Pts ≥ 65 have CI • Stayed in the hospital 1.5 days more than pts with no CI (P < 0.0001) • Cost Medicare $8,510 more than pts with no CI (P < 0.0001) • Were re-hospitalized 2 months earlier than pts with no CI (P < 0.0001) • Died 3 years earlier than pts with no CI (P < 0.0001) Boustani et al, 2005 www.indydiscoverynetwork.com

  6. Translational CycleFrom Discovery To Delivery Basic science Lab Epidemiology Clinical Observation T1 Promising Intervention System and Provider Implementation Time: 17 yrs Cost: $800 million AD recruitment rate: < 1% Clinical trial testing Post-Marketing testing T3 T2 Approved Intervention Guideline Development www.indydiscoverynetwork.com

  7. Community Partner Indianapolis Discovery Network for Dementia Clinician Researcher www.indydiscoverynetwork.com

  8. WHY We Need IDND • The Institute of Medicine recommended the need for • system thinking • integrated, productive, locally sensitive collaboration among the local community, health care systems and research organizations www.indydiscoverynetwork.com

  9. WHY We Need IDND • The IoM and the NIH Road Map • recommend urgent "Re-Engineering of the Clinical Research Enterprise." • Suggest building Practice-Based Research Network with • The lens of complexity theories • The tools of information technology www.indydiscoverynetwork.com

  10. Ambulatory Dementia Care in The Real World HCS 1 Com-Res HCS: Health Care System PCP: Primary care practice MCP: Memory care practice Com-Res: Community Resource R-I: Research Infrastructure D-Cx: Discovery Culture HCS 3 PCP PCP PCP PCP Research Organization PCP PCP MCP PCP MCP PCP HCS 2 MCP PCP PCP PCP Com-Res PCP Com-Res Research Organization www.indydiscoverynetwork.com

  11. IDND Structure R-I D-Cx Com-Res Research Organization PCP: Primary care practice MCP: Memory care practice Com-Res: Community Resource R-I: Research Infrastructure D-Cx: Discovery Culture PCP PCP PCP PCP PCP PCP PCP MCP Research Organization R-I D-Cx MCP Com-Res PCP MCP R-I D-Cx Com-Res PCP PCP PCP R-I D-Cx PCP www.indydiscoverynetwork.com

  12. Research Infrastructure & Discovery Culture • Research Infrastructure: • Minimum Standardized Approach • Practical & Electronic Data Collection • Protocol Development • IRB Submission • Recruitment Methods • Formative Evaluation • Publication support • Discovery culture: • Reflective Adaptive Process • Consultancy rounds • Story telling • Appreciative Inquiry • Quarterly meeting • Annual summit www.indydiscoverynetwork.com

  13. Case finding within The Primary Care System PREVETN II Study Primary Care Dementia Clinic (PCP + DCC)/ Focus on the Dyad: - Medical dementia Care - Relevant comorbid care - Secondary Prevention Dementia Care Needs & Coordination Periodic Assessment (DCC) Mild Complexity Moderate-Severe Complexity Community Resources: - Pt & CG Self-management - Home & Respite Care Support • Specialty Care Dementia Clinic • (DCP + DCC) / Focus on the Dyad: • Medical dementia Care DCC: Dementia Care Coordinator PCP: Primary Care Provider MCP: Dementia Care Provider Pt: Patient with dementia CG: Caregiver of patient with dementia Boustani, Callahan, Sachs. JGIM in Press www.indydiscoverynetwork.com

  14. The e-CHAMP Study Vulnerable Hospitalized Elders with CI e-CHAMP computerized Decision Support System ↓Hospital acquired complication ↓ Overall hospital cost ↓ Hospital LOS www.indydiscoverynetwork.com

  15. Primary Care Patient’s Attitudes about Dementia Screening Association with Pt’s Acceptance of Dementia Screening & Diagnosis process The PRISM-PC Study www.indydiscoverynetwork.com

  16. Drugs as risk factors for Dementia H2-Blockade Anticholinergics Antiepileptic Statins The REDS www.indydiscoverynetwork.com

  17. www.indydiscoverynetwork.com mboustani@regenstrief.org mboustan@iupui.edu 317-423-5633 Connection www.indydiscoverynetwork.com

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