Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers A Way Forward (2021) / Chapter Skim
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4 Making Decisions About Implementation
4 Making Decisions About Implementation
Pages 75-94
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From page 75... ...
Implementation testing builds the evidence base on just what benefits the intervention provides under which conditions. It also helps identify adaptations that may be needed for the intervention's successful application within different systems of care, organizational structures, workflows, payment models, and cultures, and can assist decision makers in 75
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From page 76... ...
In considering which dementia care interventions, services, and supports are ready for dissemination and implementation on a broad scale, the committee sought to understand the implementation science behind the translation of evidence-based interventions into routine practice in care settings, as well as in the community (i.e., by persons living with dementia and their care partners and caregivers)
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From page 77... ...
. It is therefore important to identify those stakeholders and end users (e.g., persons living with dementia, care partners and caregivers, health care and LTSS providers, care systems, payers, policy makers)
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78 FIGURE 4-1 Rogers's model of the diffusion of innovations. SOURCE: DIFFUSION OF INNOVATIONS, 5E by Everett M
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This framework reprioritizes eight implementation steps, so that the process starts with proactive assessment of the demand from end users rather than with the innovator's perspective and then directs the development of a scalable, sustainable solution accordingly. The framework facilitates tailoring of an intervention to the local environment; timely feedback and process modification; monitoring and assessment of impact, unintended consequences, and emergent behaviors that promote or deter uptake; and regularly updated documentation of the process to facilitate the spread and scaling of the intervention (Boustani et al., 2018; Callahan et al., 2018)
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From page 80... ...
Many persons living with dementia, care partners and caregivers, and providers are not aware of or able to access these interventions. Another challenge is the clinical relevance of the evidence.
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From page 81... ...
Policy makers, practitioners, persons living with dementia, and care partners and care ivers priori g tize knowledge about practical ways to apply interventions in their context. Although the purpose of developing dementia care interventions is to meet the needs of persons living with dementia, care partners, and caregivers, they are rarely consulted or engaged in the development or implementation process.
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From page 82... ...
In fact, services are covered only if they are provided by selected medical professionals, and not if they are provided by community-based organizations or in the context of collaborative dementia care models. One proposal to close this gap is an alternative payment model covering care management services for community-dwelling persons living with dementia.
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From page 83... ...
. This framework takes systematic reviewers and decision makers through a structured and transparent process of formulating a question based on a defined problem, making an evidence-based assessment, and drawing conclusions based on the best available research evidence.
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From page 84... ...
Monitoring and Evaluation, Quality Improvement, and Information Sharing Given that much of the learning and knowledge generation for complex systems occurs in local and individual settings, monitoring and evaluation are crucial components of intervention implementation that need to be considered from the outset of intervention development (NAE, 2011)
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From page 85... ...
. It is essential for formative evaluations to be designed to assess the perceptions of stakeholders delivering and receiving the intervention, such as persons living with dementia, care partners and caregivers, providers, and administrators (Curran et al., 2012; Damschroder et al., 2009)
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From page 86... ...
Advocacy Organizations and Associations Representatives of advocacy organizations and associations expressed to the committee their view that persons living with dementia and their care partners and caregivers need interventions and support now. They stated that decisions regarding which interventions to try, for which individuals, in which situations, with the available resources are being made using the best evidence currently available.
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From page 87... ...
In considering which interventions to try, it is important to consider the desires of persons living with dementia and care partners and caregivers and the accessibility of the interventions to them. For example, "short-term low-touch interventions" are needed in conjunction with or as an alternative to more comprehensive programs and services.
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From page 88... ...
According to Courneya, there is an opportunity to create infrastructure for the collection of pragmatic, real-world information about the effectiveness of organizations and service providers in delivering covered services consistently, and about whether the intervention's delivery is having the intended impact in the community or there are any unanticipated effects. From a decisionmaking perspective, it is important to understand who specifically derives benefits from the intervention (e.g., persons living with dementia, care partners and caregivers, employers, society, other stakeholders)
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From page 89... ...
According to Gifford, the evidence base used by decision makers would benefit from researchers drawing conclusions when possible, with caveats if needed. Lewis Sandy of UnitedHealth Group pointed out that many persons living with dementia are Medicare beneficiaries, as are many care partners and caregivers.
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From page 90... ...
. CONCLUSIONS Given the complexity of dementia care interventions, it is challenging to evaluate how and under what circumstances they can be implemented to move the evidence base beyond efficacy and even pragmatic trials toward readiness for implementation and dissemination.
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From page 91... ...
2019. An alternative payment model to support widespread use of collaborative dementia care models.
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From page 92... ...
2009. Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science.
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From page 93... ...
2020. What is implementation science?
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