Project Incorporates Alzheimer's into Care
"People with Alzheimer's and other dementias don't receive intentional, ongoing medical management," said Katie Maslow, director of the Initiative on Alzheimer's and Managed Care at the Alzheimer's Association, Washington, D.C. Even though they usually have a primary care physician, she explained, medical care for these patients doesn't integrate their dementia with care for their other conditions.
Maslow described a new model for dementia care, Chronic Care Networks for Alzheimer's Disease (CCN/AD), developed by the Alzheimer's Association in partnership with the now-defunct National Chronic Care Consortium. During a symposium at the 2003 Joint Conference of the National Council on the Aging and the American Society on Aging in Chicago last spring, Maslow explained that the model includes a set of objectives and interventions for medical management and other areas of care "that bridge the medical and nonmedical side." The nonmedical side includes legal and financial issues, psychosocial care and family support that might involve interventions by healthcare professionals or Alzheimer's Association chapter staff working with the client and the family.
The project selected eight sites nationwide and required two years of development before its implementation in 1999. Participating networks ranged from one in upstate New York that included the U.S. Department of Veterans Affairs as the provider and four Alzheimer's Association chapters serving the region, to one in San Francisco comprising the Bay Area's association chapter and four different provider groups. Besides addressing the patient-care concerns, she said, success depended on painstaking efforts to craft the model in ways that would fit practically into each provider's system. Maslow stressed, "Starting with the people who were going to test the model and having them be part of defining it was part of the reason we succeeded."
The model had four major parts intended to address difficulties that often "cause bad outcomes for people with Alzheimer's and other dementias," she said. These included early identification, an initial assessment for dementia, blueprints for ongoing management of medical and nonmedical care, and caregiver information and support. Flexibility was also essential to developing a replicable approach, Maslow said. She said the project was set up as a "learning laboratory," so that participants could make adjustments while they were implementing the program.
Although outcomes are still being evaluated, Maslow discussed the promising work in Denver-"our most successful site"-especially the collaboration with PacifiCare of Colorado, an independent physician association of about 60 doctors with a Medicare-Plus-Choice HMO plan. CCN/AD provided a project manager, and the Denver Alzheimer's Association added a staff of over 25 employees and a care-consultation program. …