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Cost-saving, coordinated brain care model for older adults attracting nationwide interest


INDIANAPOLIS — The patient and caregiver-centered Aging Brain Care program, developed by researchers at the Regenstrief Institute and the Indiana University Center for Aging Research, is attracting nationwide interest for its ability to improve health outcomes and quality of care for those with cognitive impairment while dramatically lowering costs to patients and health care systems.

On May 22 and 23, a team of physicians and nurse managers from the Geisel School of Medicine at Dartmouth and the Dartmouth-Hitchcock Medical Center will visit Indianapolis to learn more about the innovative Aging Brain Care model — ABC for short — and how implementation science is bringing rapid health improvement to older adults at lower cost. In June, a team from the Center for Health Innovation and Implementation Science and the ABC program will travel to New Hampshire to follow up with on-site training at Dartmouth.

“Our goal is no less than to transform how health care systems in communities across the nation provide care to these vulnerable patients — improving quality of life for older adults and saving money,” said Malaz Boustani, M.D., MPH, who developed the ABC model. He is chief operating officer of the Center for Health Innovation and Implementation Science at Indiana University School of Medicine. The ABC model was the initial product of the Center for Health Innovation and Implementation Science and one of the center’s growing number of population health management programs.

“Now that we have tested the ABC model in large clinical trials and shown that it improves care at a lower cost than standard care, we are training health care professionals from around the country in how to implement this patient- and caregiver-focused therapy at their own sites,” Dr. Boustani said.

“By redesigning how older adults with dementia or depression are cared for, we are improving their lives and the lives of their caregivers, simultaneously saving an enormous of amount of health care dollars — conceivably billions of dollars nationwide,” said Dr. Boustani, who is also chief innovation and implementation officer at Indiana University Health, a Regenstrief and an IU Center for Aging Research investigator, and an associate professor of medicine at the IU School of Medicine.

ABC, which can be adapted to a variety of care settings, is a team-based medical home dementia care model that supports and supplements the efforts of primary care providers. Using the tools, software and care protocols developed by Dr. Boustani and colleagues, the ABC team can identify, assess and manage the biopsychosocial needs of patients with dementia and their family caregivers with much greater success than usual care. The patient’s primary care physician retains ultimate medical decision-making responsibility.

In January 2011, Dr. Boustani and colleagues published a study in Aging & Mental Health reporting that the ABC model reduces emergency department visits and hospitalizations, and successfully encourages use of medications that are not harmful to older brains. In a study published in the April 2014 issue of the journal Health Affairs, the ABC model was shown to generate an annual net cost savings of up to $2,856 per patient. Both studies were conducted at Eskenazi Health (formerly Wishard Health), one of the nation’s five largest safety net health systems, where the ABC model was first implemented.

The Center for Health Innovation and Implementation Science uses the tools of implementation science and population health management to rapidly translate and implement high-quality, cost-effective health care delivery solutions within local, regional, national and international health care systems, striking a balance between the strengths of both academic medicine and corporate health care. The center offers a variety of population health management and implementation science training programs. Future plans call for the center to offer certificate and master’s-level training in health innovation, population management and implementation science.