Implementing and sustaining family care programs in real-world settings: Barriers and facilitators

Hodgson, Nancy; Gitlin, Laura N.

doi:10.1016/b978-0-12-813898-4.00006-3

Cited by 18 publications

(16 citation statements)

References 58 publications

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“…Little research on sustainability has been conducted nor have ERIC strategies relevant to sustainability been widely used. 21 Pilot or ePCT studies are not typically designed to address sustainability-type research questions. However, considering sustainability upfront at the pilot/ePCT stage can inform decision-making about implementation processes that may ultimately impact the future dissemination and wide-scale implementation of interventions in HCSs.…”

Section: Sustainabilitymentioning

confidence: 99%

“…60 For example, two key driving (positive) forces found to be successful in an analysis of 28 studies translating dementia care programs for delivery in HCSs included assessing the stakeholder's readiness for implementation and tailoring and adapting the intervention to the practice setting. 21 Two constraining forces identified in these studies included the lack of engagement of caregivers during implementation and the lack of attention to payment approaches to support eventual sustainability. 21 Lewin (1951) 43 advised that attention to constraining forces is essential to propel change (implementation of evidence-based program and its maintenance).…”

Section: Sustainabilitymentioning

confidence: 99%

“…21 Two constraining forces identified in these studies included the lack of engagement of caregivers during implementation and the lack of attention to payment approaches to support eventual sustainability. 21 Lewin (1951) 43 advised that attention to constraining forces is essential to propel change (implementation of evidence-based program and its maintenance). For instance, despite attention to driving forces, such as having well-developed training plans or providing technical assistance and coaching for dementia care staff, insufficient attention to payment mechanisms may diminish or negate these positive driving forces, leading to ineffective efforts at dissemination and wide-scale implementation.…”

Section: Sustainabilitymentioning

confidence: 99%

“…20 Of the few evidence-based programs evaluated in HCSs, none has been widely disseminated thereafter nor sustained. 21 Consequently, we do not know how interventions function or how outcomes are impacted when implementation occurs in "real-world," complex organizational and payment structures. Nor do we know which strategies are most effective for implementing proven dementia care programs that result in wide-scale dissemination and sustained usage.…”

Section: Introductionmentioning

confidence: 99%

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Dissemination and Implementation of Evidence‐Based Dementia Care Using Embedded Pragmatic Trials

Gitlin

Baier

Jutkowitz

et al. 2020

J American Geriatrics Society

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There are many nonpharmacologic interventions tested in randomized clinical trials that demonstrate significant benefits for people living with Alzheimer's disease (AD) and ADrelated dementia, their care partners, or professional care providers. Nevertheless, with few exceptions, proven interventions have not been translated for delivery in real-world settings, such as home care, primary care, hospitals, community-based services, adult day services, assisted living, nursing homes, or other healthcare systems (HCSs). Using embedded pragmatic clinical trial (ePCT) methods is one approach that can facilitate dissemination and implementation (D&I) of dementia care interventions. The science of D&I can inform the integration of evidence-based dementia care in HCSs by offering theoretical frameworks that capture field complexities and guiding evaluation of implementation processes. Also, D&I science can suggest evidence-based strategies for implementing dementia care in HCSs. Although D&I considerations can inform each stage of dementia care intervention development, it is particularly critical when designing ePCTs. This article examines fundamental considerations for implementing dementia-specific interventions in HCSs and how best to prepare for successful dissemination upstream in the context of ePCTs, thereby illustrating the critical role of the D&I Core of the National Institute on Aging Imbedded Pragmatic Alzheimer's Disease and AD-Related Dementias Clinical Trials Collaboratory. The scientific premise of the D&I Core is that having the "end" in mind, upfront in the design and testing of dementia care programs, can lead to decision-making that optimizes the ultimate goal of wide-scale D&I of evidencebased dementia care programs in HCSs.

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Section: Sustainabilitymentioning

confidence: 99%

Section: Sustainabilitymentioning

confidence: 99%

Section: Sustainabilitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dissemination and Implementation of Evidence‐Based Dementia Care Using Embedded Pragmatic Trials

Gitlin

Baier

Jutkowitz

et al. 2020

J American Geriatrics Society

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“…Studies consistently show that more than one half of Black American caregivers provide care-related assistance for more than one individual, and 25% report spending an average of 21 h/week providing care ( Alzheimer’s Association, 2019 ; National Alliance for Caregiving, 2015 ). Unfortunately, Black caregivers are underrepresented in nonpharmacological studies and have limited access to evidence-based services like adult day services (ADS) that can provide opportunities for respite and assist with care needs ( Gitlin et al, 2015 ; Hodgson & Gitlin, 2021 ).…”

mentioning

confidence: 99%

Does Adult Day Service Use Improve Well-Being of Black Caregivers of People Living With Dementia?

Parker

Gitlin

2021

Innovation in Aging

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Background and Objectives Despite adult day services (ADS) being the most racially diverse home-and-community based service (HCBS), there is a paucity of research that has examined the impact of ADS on well-being measures among Black caregivers of people living with dementia. To address this gap, this study examined the association between the use of ADS and depressive symptoms among Black dementia caregivers. Research Design and Methods Using baseline data from two behavioral intervention trials: Advancing Caregiver Training (ACT, n=72) and Care of Persons with Dementia in their Environments (COPE, n=63), we conducted ordinary least squares regression to examine the association between ADS use in the past six months and depressive symptoms (n=135). The dependent variable, depressive symptoms, was assessed by the 10-item Center for Epidemiologic Studies Scale (CES-D). The independent variable was assessed by self-report of ADS use in the past six months. Results Nearly 36% of the sample used ADS in the past six months. After controlling for caregiver characteristics associated with depression (burden, social support, self-rated health, caregiving relationship status, years caregiving, religious/spiritual coping and demographic characteristics), caregivers who utilized ADS had a lowered CES-D score (B= -1.97, p=0.03) compared to those who did not use ADS. Discussion and Implications Black dementia caregivers who utilized ADS had lower depressive symptoms compared to those who did not utilize ADS. ADS may be a critical HCBS that can provide relief to Black caregivers. Research is needed to examine additional benefits of ADS use among Black caregivers, and the policy and programming needed to enhance access to ADS.

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Cost effectiveness of non‐drug interventions that reduce nursing home admissions for people living with dementia

Jutkowitz

Pizzi

Shewmaker

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONSix million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health‐care cost driver. We evaluated the cost effectiveness of non‐pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD.METHODSWe used a person‐level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence‐based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality‐adjusted life years and incremental cost‐effectiveness ratios.RESULTSAll four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1‐way, 2‐way, structural, and probabilistic sensitivity analyses.CONCLUSIONDementia‐care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non‐pharmacologic interventions.

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Implementing and sustaining family care programs in real-world settings: Barriers and facilitators

Cited by 18 publications

References 58 publications

Dissemination and Implementation of Evidence‐Based Dementia Care Using Embedded Pragmatic Trials

Dissemination and Implementation of Evidence‐Based Dementia Care Using Embedded Pragmatic Trials

Does Adult Day Service Use Improve Well-Being of Black Caregivers of People Living With Dementia?

Cost effectiveness of non‐drug interventions that reduce nursing home admissions for people living with dementia

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