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Collaborative transdisciplinary team approach for dementia care

    James E Galvin

    *Author for correspondence:

    E-mail Address: James.Galvin@nyumc.org

    Center for Cognitive Neurology & Alzheimer Disease Center, Departments of Neurology, Psychiatry, & Population Health, New York University School of Medicine, New York, NY 10016, USA

    ,
    Licet Valois

    Center for Cognitive Neurology & Alzheimer Disease Center, Departments of Neurology, Psychiatry, & Population Health, New York University School of Medicine, New York, NY 10016, USA

    &
    Yael Zweig

    Center for Cognitive Neurology & Alzheimer Disease Center, Departments of Neurology, Psychiatry, & Population Health, New York University School of Medicine, New York, NY 10016, USA

    Published Online:https://doi.org/10.2217/nmt.14.47

    SUMMARY 

    Alzheimer's disease (AD) has high economic impact and places significant burden on patients, caregivers, providers and healthcare delivery systems, fostering the need for an evaluation of alternative approaches to healthcare delivery for dementia. Collaborative care models are team-based, multicomponent interventions that provide a pragmatic strategy to deliver integrated healthcare to patients and families across a wide range of populations and clinical settings. Healthcare reform and national plans for AD goals to integrate quality care, health promotion and preventive services, and reduce the impact of disease on patients and families reinforcing the need for a system-level evaluation of how to best meet the needs of patients and families. We review collaborative care models for AD and offer evidence for improved patient- and family-centered outcomes, quality indicators of care and potential cost savings.

    Papers of special note have been highlighted as: • of interest

    References

    • 1 Alzheimer Disease Facts and Figures 2013. www.alz.org.
    • 2 U.S. Surgeon General Office. www.surgeongeneral.gov/library/mentalhealth/chapter5/sec1.html.
    • 3 Center for Medicare and Medicaid Services - Geographic Variation Public Use. www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/index.html.
    • 4 United States Census Bureau. Annual projections of the resident population by age, sex, race and hispanic origin: lowest, middle, highest series and zero international migration series, 1999 to 2100. www.census.gov/population/projections/data/national/np-d1.html.
    • 5 Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: Key Indicators of Well-Being. Federal Interagency Forum on Aging-Related Statistics. US Government Printing Office, Washington, DC, USA (2010). www.agingstats.gov/Main_Site/Data/Data_2010.aspx.
    • 6 Roett MA, Coleman MT. Practice improvement, part II: collaborative practice and team-based care. FP Essent. 414, 11–18 (2013).
    • 7 Sommers LS, Marton KI, Barbaccia JC, Randolph J. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Arch. Intern. Med. 160(12), 1825–1833 (2000).
    • 8 Goodrich DE, Kilbourne AM, Nord KM, Bauer MS. Mental health collaborative care and its role in primary care settings. Curr. Psychiatry Rep. 15(8), 383 (2013).
    • 9 Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: system review and meta-analysis. Am. J. Psychiatry 169, 790–804 (2012).
    • 10 Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 74, 511–544 (1996).• Seminal paper describing the chronic care model basis for collaborative care.
    • 11 Politi MC, Wolin KY, Légaré F. Implementing clinical practice guidelines about health promotion and disease prevention through shared decision making. J. Gen. Intern. Med. 28(6), 838–844 (2013).
    • 12 Makoul G, Clyman ML. An integrative model of shared decision making in medical encounters. Patient Educ. Couns. 60, 301–312 (2006).• Characterizes the principle of shared decision making which is particularly relevant for patients with cognitive impairment
    • 13 Coylewright M, Montori V, Ting HH. Patient-centered shared decision making: a public imperative. Am. J. Med 125, 545–547 (2012).
    • 14 Elwyn G, Frosch D, Thomson R et al. Shared decision making: a model for clinical practice. J. Gen. Intern. Med. 27, 1361–1367 (2012).
    • 15 Boustani MA, Sachs GA, Alder CA et al. Implementing innovative models of dementia care: The Healthy Aging Brain Center. Aging Mental Health. 15(1), 13–22 (2011).• Outstanding example of developing a comprehensive collaborative care for older adults with depression and dementia as a free standing clinic.
    • 16 Boustani MA, Munger S, Gulati R, Vogel M, Beck RA, Callahan CM. Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system. Clin. Interv. Aging 5, 141–148 (2010).
    • 17 Callahan CM, Boustani MA, Unverzagt FW et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care. JAMA 295(18), 2148–2157 (2006).
    • 18 Callahan CM, Boustani MA, Weiner M et al. Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home. Aging Mental Health. 15(1), 5–12 (2011).• Outstanding example of developing a comprehensive collaborative care for older adults with depression and dementia in a medical home setting.
    • 19 Callahan CM, Weiner M, Counsell SR. Defining the domain of geriatric medicine in an urban public health system affiliated with an academic medical center. J. Am. Geriatr. Soc. 56(10), 1802–1806 (2008).
    • 20 Massoud F, Lysy P, Bergman H. Care of dementia in Canada: a collaborative care approach with a central role for the primary care physician. J. Nutr. Health Aging 14(2), 105–106 (2010).
    • 21 Reuben DB, Evertson LC, Wenger NS et al. The University of California at Los Angeles Alzheimer's and Dementia Care program for comprehensive, coordinated, patient-centered care: preliminary data. J. Am. Geriatr. Soc. 61(12), 2214–2218 (2013).
    • 22 Ganz D, Koretz BK, Bail JK et al. Nurse practitioner comanagement for patients in an academic geriatric practice. Am. J. Managed Care 16(12), 343–355 (2010).• Describes the impact of nurse practitioner comanagement of multiple chronic conditions and improved health outcomes and satisfaction.
    • 23 Vickrey B, Mittman BS, Connor KI et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann. Int. Med. 145(10), 713–726 (2006).• A randomized clinical trial demonstrating the benefits of care coordination to improve dementia outcomes and care quality.
    • 24 Callahan C, Boustani MA, Schmid AA et al. Alzheimer's disease multiple intervention trial (ADMIT): study protocol for a randomized controlled clinical trial. Trials 13(92), 1–10 (2012).
    • 25 Lee L, Hillier LM, Stolee P et al. Enhancing dementia care: a primary care-based memory clinic. J. Am. Geriatr. Soc. 58, 2197–2204 (2010).
    • 26 French DD, LaMantia MA, Livin LR, Herceg D, Alder CA, Boustani MA. Healthy aging brain center improved care coordination and produced net savings. Health Aff. (Millwood) 33(4), 613–618 (2014).
    • 27 Turner S, Iliffe S, Downs M. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing 33 461–467 (2004).
    • 28 Litaker D, Mion L, Planavsky L, Kippes C, Mehta N, Frolkis J. Physician: nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients’ perception of care. J. Interprof. Care 17(3), 223–237 (2003).
    • 29 American Nurses Association. The Value of Nursing Care Coordination: A White Paper of the American Nurses Association. (2012). www.nursingworld.org/carecoordinationwhitepaper.
    • 30 Lamb G, Zimring C, Chuzi J, Dutcher D. Designing better healthcare environments: interprofessional competencies in healthcare design. J. Interprof. Care 24(4), 422–435 (2010).
    • 31 Balanced Budget Act of 1997, 42 USC section 1395x(aa)(6). (1997). www.govtrack.us/congress/bills/105/hr2015.
    • 32 Brown AF, Vassar SD, Connor KI, Vickrey BG. Collaborative care management reduces disparities in dementia care quality for caregivers with less education. J. Am. Geriatr. Soc. 61(2), 243–251 (2013).
    • 33 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2010. Volumes 1 and 2, Chap. 11, 11–20. www.healthypeople.gov.
    • 34 Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. (2008).
    • 35 Institute of Medicine. Committee on the Future Health Care Workforce for Older Americans, January 2007, summarized in Iglehart JK, Medicare, Graduate Medical Education and New Policy Directions. N. Engl. J. Med. 359, 643–650 (2008).
    • 36 Institute of Medicine. Linking Research and Public Health Practice. National Academy Press, Washington, DC, USA (1997).
    • 37 Phelan EA, Cheadle A, Schwartz SJ et al. Promoting health and preventing disability in older adults. Com. Health 26, 214–20 (2003).
    • 38 Galvin JE, Tolea MI, George N, Wingermuehle C. Public-private partnerships improve health outcomes in individuals with early stage Alzheimer's disease. Clin. Interv. Aging 9, 621–630 (2014).• Highlights the impact of care consultations and psychosocial assessments to improve health outcomes and potential cost savings.
    • 39 Kong EH, Evans LK, Guevara JP. Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis. Aging Mental Health. 13(4), 512–520 (2009).
    • 40 Kales HC, Gitlin LN, Lyketsos CG. Detroit Expert Panel on Assessment and Management of Neuropsychiatric Symptoms of Dementia. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. J. Am. Geriatr. Soc. 62(4), 762–769 (2014).• Important review of nonpharmacological interventions for neuropsychiatric symptoms of dementia with evidence-based recommendations.
    • 41 Guerriero Austrom M, Damush TM et al. Development and implementation of nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families in a multiracial primary care setting. Gerontologist 44(4), 548–53 (2004).
    • 42 Herbert R, Bravo G, Preville M. Reliability, validity, and reference values of the Zarit Burden Interview for assessing informal caregivers of community-dwelling older persons with dementia. Can. J. Aging 19, 494–507 (2000).
    • 43 Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics 50(6), 613–621 (2009).
    • 44 Lawson B, Dicks D, Macdonald L, Burge F. Using quality indicators to evaluate the effect of implementing an enhanced collaborative care model among a community, primary healthcare practice population. Nurs. Leadersh. (Tor. Ont.) 25(3), 28–42 (2012).
    • 45 Practice parameters for diagnosis and evaluation of dementia: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 44, 2203–2206 (1994).
    • 46 Public Law 111–148. Patient Protection and Affordable Care Act. www.gpo.gov/fdsys/pkg/PLAW-111publ148/content-detail.html.
    • 47 U.S. Department of Health and Human Services. National plan to address Alzheimer's disease. http://aspe.hhs.gov/daltcp/napa/natlplan.shtml.