Design, Implement, and Diffuse Scalable and Sustainable Solutions for Dementia Care

Malaz Boustani MD, MPH; Jürgen Unützer MD, MPH, MA; Luci K. Leykum MD, MBA, MSc

Disclosures

J Am Geriatr Soc. 2021;69(7):1755-1762. 

In This Article

Abstract and Introduction

Abstract

Most innovations developed to reduce the burden of Alzheimer disease and other related dementias (ADRD) are difficult to implement, diffuse, and scale. The consequences of such challenges in design, implementation, and diffusion are suboptimal care and resulting harm for people living with ADRD and their caregivers. National experts identified four factors that contribute to our limited ability to implement and diffuse of evidence-based services and interventions for people living with ADRD: (1) limited market demand for the implementation and diffusion of effective ADRD interventions; (2) insufficient engagement of persons living with ADRD and those caring for them in the development of potential ADRD services and interventions; (3) limited evidence and experience regarding scalability and sustainability of evidence-based ADRD care services; and (4) difficulties in taking innovations that work in one context and successfully implementing them in other contexts. New investments in the science of human-centered design, implementation, and diffusion are crucial for meeting the goals of the National Plan to Address Alzheimer's Disease under the auspices of the National Alzheimer's Project Act.

Introduction

Over the past two decades, the National Institutes of Health in general and the National Institute on Aging in particular have been investing heavily in biomedical research to reduce the individual, family, and society burden of Alzheimer disease and other related dementias (ADRD). However, most innovations generated by this large intellectual and financial investment have not specifically been designed for scalability, have not been successfully implemented outside research settings, and are poorly diffused across the various complex adaptive healthcare delivery organizations.[1,2] The consequences of such challenges in design, implementation, and diffusion are continued suboptimal care and resulting harm for people living with ADRD and their caregivers.[1–7] New investments in the science of human-centered design, implementation, and diffusion are crucial for meeting the goals of the National Plan to Address Alzheimer's Disease under the auspices of the National Alzheimer's Project Act.

As part of the 2020 "National Research Summit on Care, Services, and Supports for Persons with Dementia and their Caregivers," national experts were convened to identify gaps and opportunities to improve intervention research relating to ADRD care and caregiving that targets individuals, dyads, or organizations and approaches to improve the implementation and dissemination of evidence-based interventions, including strategies to motivate systems change to promote adoption and sustainability. The implementation and diffusion of evidence-based scalable interventions must have sufficient fidelity in a variety of real-world settings to improve quality of care and quality of life for persons living with ADRD and their caregivers. This paper summarizes the current challenges and implications relevant to the science of human-centered design, implementation, and diffusion, and reflects on relevant lesson learned from the discovery-to-delivery journey of the evidence-based collaborative care model for persons living with depression.

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