UC San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC) have been awarded a $10 million grant from the Centers for Medicare & Medicaid (CMS) Innovation to create a new Web-based model of dementia care. It will provide around the clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.
The Dementia Care Ecosystem will not replace clinicians; it will bring educational resources developed over the last decade by the UCSF Memory and Aging Center to patients and their families, while enabling clinicians to monitor their patients off site.
Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard, created with the help of Salesforce. Navigators will be people without a formal medical degree and will be supervised by nurses, social workers and pharmacists with expertise in dementia care.
The navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall. Meanwhile, patients and their families will be able to get training online to help make financial plans and work through medical decisions before their loved ones have reached a crisis stage.
Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs. Nearly 60 percent said the work was highly stressful and more than a third reported symptoms of depression.
Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home. A small number will have sensors placed inside their homes to detect behavior changes that could signal the onset of a health problem, like being up all night, staying in bed all day or going to the bathroom more times than usual.
The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.
Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months. This is projected to save $4.3 million over the three years of the grant.
Beginning this fall, 2,100 patients, all diagnosed with varying stages of dementia, will be enrolled through San Francisco General Hospital and Trauma Center, UCSF Medical Center and the UCSF MAC clinics and Chinatown Clinics, as well as UNMC and other service organizations in Nebraska serving the elderly.