ED-LEAD: Emergency Departments Leading the Transformation of Alzheimer's and Dementia Care

Study Overview
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Brief Summary
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The purpose of this study is to improve the care of persons living with dementia (PLWD) and their informal care partners by addressing emergency and post-emergency care through different combinations of three PLWD-care partner dyad focused interventions. The primary aims are to use coaching to help connect PLWD and their care partners with community support and services to improve transitional care, quality of care, care satisfaction and reduce future ED visits and hospitalizations.

Official Title
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ED-LEAD: Emergency Departments Leading the Transformation of Alzheimer's and Dementia Care

Conditions
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Alzheimer's Disease Related Dementia, Alzheimer Disease

Intervention / Treatment
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* Behavioral: Emergency Care Redesign (ECR)
* Behavioral: Nurse-led Telephonic Care (NLTC)
* Behavioral: Community Paramedic-led Transitions Intervention (CPTI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients age 66 and older have two or more ICD-10 visit diagnoses (one of which must be ambulatory) for Alzheimer's Disease or Alzheimer's Disease Related Dementias (AD/ADRD) care partners age 18 and older Exclusion Criteria: patients who are under 66 years old

Ages Eligible for Study
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Minimum Age: 66 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: No intervention<br>No intervention, serving as a usual care control group | |
| Experimental: Single intervention: Emergency Care Redesign (ECR)<br> | Behavioral: Emergency Care Redesign (ECR)<br>* Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services<br>|
| Experimental: Single intervention: Nurse-led Telephonic Care (NLTC)<br> | Behavioral: Nurse-led Telephonic Care (NLTC)<br>* Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call  30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers<br>|
| Experimental: Single intervention: Community Paramedic-led Transitions Intervention (CPTI)<br> | Behavioral: Community Paramedic-led Transitions Intervention (CPTI)<br>* Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within  5 days of index ED visit. One home visit and three telephone encounters over 30 days<br>|
| Experimental: Two intervention: ECR and NLTC<br> | Behavioral: Emergency Care Redesign (ECR)<br>* Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services<br>Behavioral: Nurse-led Telephonic Care (NLTC)<br>* Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call  30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers<br>|
| Experimental: Two interventions: ECR and CPTI<br> | Behavioral: Emergency Care Redesign (ECR)<br>* Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services<br>Behavioral: Community Paramedic-led Transitions Intervention (CPTI)<br>* Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within  5 days of index ED visit. One home visit and three telephone encounters over 30 days<br>|
| Experimental: Two interventions: NLTC and CPTI<br> | Behavioral: Nurse-led Telephonic Care (NLTC)<br>* Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call  30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers<br>Behavioral: Community Paramedic-led Transitions Intervention (CPTI)<br>* Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within  5 days of index ED visit. One home visit and three telephone encounters over 30 days<br>|
| Experimental: All interventions: ECR, NLTC, and CPTI<br> | Behavioral: Emergency Care Redesign (ECR)<br>* Care Process Redesign: Care process redesign with a shared structured worksheet for data gathering, standardized assessment and referral. Education of all providers (Physician, Nurse, and Social Work Champion) on new processes at huddles and via on-line training, smart phone-compatible animated videos, faculty meetings, e-mail and from ED champions on shift CDS System: Alerts and new workflow to refer the dyad to social work or care manager. Continued use throughout study period and beyond Follow up: Within 72 hours of ED visit if discharged home Social Work Champion will have a single phone call. Triadic telephone encounter to ensure understanding of discharge plan, medication management and connection to community services<br>Behavioral: Nurse-led Telephonic Care (NLTC)<br>* Telephonic support for dyad for safe ED to home care transition, and to enhance knowledge and management of AD/ADRD and co-morbid conditions. First call to dyad within 72 hours of index ED visit from Registered nurses. Each call  30 minutes depending on needs and willingness of dyad. Calls also occur at 14 days, and at least monthly thereafter for 6 months. Dyad or nurse can initiate additional as-needed calls and coordinate care and care needs with other providers<br>Behavioral: Community Paramedic-led Transitions Intervention (CPTI)<br>* Community paramedics to provide coaching with dyad to improve medication management, outpatient follow up, understanding of red flags necessitating medical care. Home visit within  5 days of index ED visit. One home visit and three telephone encounters over 30 days<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Emergency Department (ED) revisits |  | Up to 30 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of ED revisits |  | Up to 14 days | 
| Number of ED revisits |  | Up to 6 months | 
| Number of hospitalizations |  | Up to 14 days | 
| Number of hospitalizations |  | Up to 30 days | 
| Number of hospitalizations |  | Up to 6 months | 
| Number of healthy days at home |  | Up to 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dementia