Study finds novel population health management program yields major health improvement
INDIANAPOLIS — The Aging Brain Care Medical Home, a novel population health management program implemented in the homes of older adults, achieves significant health improvement for individuals with depression and also substantial stress reduction in family caregivers of dementia patients, according to a new study by investigators from the Regenstrief Institute, Indiana University Center for Aging Research and Eskenazi Health.
The researchers report at least a 50 percent reduction in symptoms in two-thirds of patients with moderately severe depressive symptoms such as feeling hopeless, feeling bad about oneself or having trouble concentrating. They also found a 50 percent reduction in stress symptoms in half of caregivers of patients with dementia.
“Depression and dementia, which typically impact other medical conditions, are difficult for primary care doctors to treat during their limited time with patients,” said Regenstrief Institute investigator and IU Center for Aging Research scientist Michael LaMantia, M.D., MPH, who led the study. “The Aging Brain Care Medical Home program may be an attractive option in response to some of the challenges posed by our nation’s rapidly aging population and the anticipated lack of geriatricians and primary doctors to care for them.
“Care coordinator assistants go to patients’ homes, develop relationships with them, evaluate the safety of the home environment, focus on the needs of both patients and caregivers, and offer support to deal with the many consequences of a depression or dementia diagnosis. We send our teams out to patients’ homes with the tools they will need to work with older adults. Our team members are our front line who alert us to problems the medical team wouldn’t otherwise know about.”
Prior to joining the ABC Medical Home team and working with older adults, the care coordinator care assistants, who only have a high school diploma or two-years of post-high school education, participate in a two-week bootcamp that includes interaction with simulated patients. They also attend lectures, participate in discussions, observe home visits and initially work with more experienced members of the team.
Supervised by a nurse and other members of the team that includes a social worker and a geriatrician, the care coordinator assistants monitor symptom burden, coach patients with history of depression on implementing behavioral activation and relapse prevention activities. They also work with the family caregivers of those with dementia on implementing caregiver stress prevention strategies such as attending monthly support groups, creating crisis plans, taking regular weekly time off from caregiving tasks, and enhancing their self-management and problem solving capacity related to their loved one’s dementia symptoms. In this study, ABC Medical Home participants received an average of 13 home visits over the 18-month period for which the preliminary data reported in the study was captured.
The ABC Medical Care team is automatically and immediately informed through the Indiana Network for Patient Care if a patient visits an emergency department or is admitted to a hospital anywhere in the state, enabling the team to coordinate services the patient will need upon discharge.
“The Aging Brain Care Medical Home: Preliminary Data” appears online in advance of print publication in the Journal of the American Geriatrics Society. Authors in addition to Dr. LaMantia are Christopher M. Callahan, M.D., and Malaz Boustani, M.D., MPH, of the Regenstrief Institute, IU Center for Aging Research and IU School of Medicine; Sujuan Gao, Ph.D., of the Regenstrief Institute and IU School of Medicine; Dustin D. French, Ph.D., of Northwestern University and VA Health Services and Development Service, Chicago; Mary G. Austrom, Ph.D., of IU School of Medicine and IU Alzheimer’s Disease Center; Catherine A. Alder, JD, MSW; Karim Boustany, Ph.D., and Lee Livin, MBA, of Eskenazi Health; and Bharath Bynagari of MavenSphere, Inc.
The project was supported by a grant (1C1CMS331000-01-00) from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of the JAGS publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.