Indian Transforming Alzheimer's Care Training

RESEARCH PROJECT 1: ABSTRACT The American Indian and Alaska Native (AI/AN) population is growing 3 times faster than the US all-races population.

The number of AI/ANs aged 65+ is expected to triple to 1,624,000 by 2050, while the number of those aged 85+ will increase 7-fold to 300,000.

These trends raise concerns about proportionate increases in Alzheimer?s disease and related dementias (ADRD) among AI/AN elders, and concurrent demands for ADRD healthcare and services.

Many AI/ANs obtain healthcare through a fragmented system that offers minimal geriatric or specialty care and creates barriers to obtaining high-quality care, resulting in late or under-diagnosis and inadequate care for ADRD.

AI/AN elders typically receive their healthcare from primary care physicians (PCPs), who often lack the training and resources needed to diagnose and manage ADRD.

The focus of the 2016 Alzheimer?s Disease-Related Dementias Summit was on improving skills in the community by training health professionals in dementia diagnosis, care, and research. PCPs are especially well-placed to detect mild cognitive impairment, which is often undiagnosed.

While studies suggest that clinic-level interventions can improve ADRD diagnosis and care, no pragmatic trial has focused on facilities or PCPs that serve AI/ANs.

In partnership with an urban clinic serving AI/ANs, we therefore designed ?INdians Transforming Alzheimer?s Care Training? (INTACT), a clinic-level intervention to improve ADRD diagnosis and quality of care for AI/ANs. The active principal component of INTACT is PCP training in screening, diagnosis, and care for ADRD.

Other elements include patient and family education, culturally informed videos, and brochures to create a ?dementia- friendly clinic?.

First, we will conduct key informant interviews with PCPs in rural clinics to adapt the existing version of INTACT for delivery in rural settings.

Second, we will test INTACT with a group-randomized trial at 14 urban and 14 rural clinics that provide primary care to AI/ANs using a wait-control design. At the clinic level, we will rely on electronic medical records to document INTACT?s effect on new ADRD diagnoses.

At the PCP level, we will test whether INTACT increases self-reported knowledge and confidence in dementia assessment, ADRD care, and caregiver support. Third, we will evaluate INTACT?s effect on clinic- and patient-level outcomes.

Although we will not collect data directly from patients, we will examine patient-level quality of care metrics documented in electronic medical records for AI/ANs with ADRD.

Our Specific Aims are to: 1) Adapt INTACT for use in rural clinics serving AI/ANs; 2) Conduct a GRT to test INTACT?s effects on PCP knowledge of ADRD, care confidence, and practice behavior; and 3) Evaluate INTACT?s effect on clinic-level outcomes (new diagnoses) and patient-level quality of care outcomes (e.g., treatments commonly used for ADRD).

The rapid growth of the elderly AI/AN population forecasts a ballooning number of Native elders at risk of ADRD.

This study will be one of the few trials of a clinic-level intervention that foregrounds PCP education and training to improve ADRD care, and the only one designed for AI/AN communities.