Indianapolis Discovery Network for Dementia 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

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%)

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

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

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

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

Clinician Community Partner Researcher I ndianapolis D iscovery N etwork for D ementia

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 WHY We Need IDND

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

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

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

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

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

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

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

The REDS Drugs as risk factors for Dementia –H2-Blockade –Anticholinergics –Antiepileptic –Statins

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