Sideman Alissa B, Dulaney Sarah, Merrilees Jennifer, Barclay Michelle, Hernandez de Jesus Alma, Possin Katherine L
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA.
The Global Brain Health Institute, University of California, San Francisco, California, USA.
J Am Geriatr Soc. 2025 Jan 6. doi: 10.1111/jgs.19363.
Dementia represents a growing healthcare challenge in the United States. The Care Ecosystem, an effective collaborative care model, bridges medical and social care needs for individuals with dementia. The purpose of this study was to describe how the Care Ecosystem has been disseminated and the lessons learned from this experience.
Interested site leaders from both health systems and community-based organizations reviewed online implementation support materials and consulted with Care Ecosystem directors. Those that decided to move forward with implementation were invited to join monthly 'Implementation Meetings.' Observations of these meetings and review of minutes were combined with site surveys and interviews, which were analyzed using qualitative and descriptive methods.
Implementation efforts resulted in the adoption of the Care Ecosystem at 28 health systems and eight community-based organizations, including 22 participants in Medicare's Guiding an Improved Dementia Experience (GUIDE) payment model. The Implementation Meetings facilitated collaborative learning and adaptation and supported fidelity to core model elements. The Care Ecosystem's flexible approach and open-source materials enabled tailored implementations that align with local contexts and population needs.
The Care Ecosystem exemplifies a scalable approach to dementia care, guided by implementation science principles to bridge the gap between research and real-world application. Its success in improving patient outcomes and reducing healthcare costs underscores its potential to enhance dementia care delivery on a broader scale. Future efforts should focus on refining implementation strategies, enhancing fidelity monitoring, and expanding partnerships to sustain and scale effective dementia care practices across diverse healthcare settings.
在美国，痴呆症给医疗保健带来了日益严峻的挑战。护理生态系统是一种有效的协作护理模式，它能够满足痴呆症患者的医疗和社会护理需求。本研究的目的是描述护理生态系统是如何得到推广的，以及从这一经验中吸取的教训。
来自医疗系统和社区组织的感兴趣的站点负责人查阅了在线实施支持材料，并咨询了护理生态系统主任。那些决定推进实施的人员被邀请参加每月一次的“实施会议”。对这些会议的观察和会议记录的审查与站点调查和访谈相结合，并使用定性和描述性方法进行分析。
实施工作促使28个医疗系统和8个社区组织采用了护理生态系统，其中包括22名参与医疗保险的改善痴呆症体验（GUIDE）支付模式的参与者。实施会议促进了协作学习和调整，并支持对核心模型要素的忠诚度。护理生态系统灵活的方法和开源材料使定制实施能够符合当地情况和人群需求。
护理生态系统体现了一种可扩展的痴呆症护理方法，以实施科学原则为指导，弥合研究与实际应用之间的差距。它在改善患者结局和降低医疗成本方面的成功凸显了其在更广泛范围内加强痴呆症护理服务的潜力。未来的努力应集中在完善实施策略、加强忠诚度监测以及扩大伙伴关系，以在不同的医疗环境中维持和扩大有效的痴呆症护理实践。
