The NIA IMPACT Collaboratory: transforming dementia care rhrough embedded pragmatic clinical trials [abstract]
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Background: More than 5 million Americans are living with Alzheimer’s disease or a related dementia, and that number is expected to triple in the next three decades. People with dementia (PWD) have higher rates of hospital stays, emergency room visits, skilled nursing facility stays, and overall health care utilization. Caregivers of PWD experience increased anxiety, depression, and stress. It is imperative that health systems address this large and growing unmet need to improve symptom management for PWD and minimize caregiver strain. A disconnect between research evidence showing that nonpharmacologic interventions improve outcomes for PWD and their caregivers and real-world health care systems has stymied the adoption of promising interventions. Embedded pragmatic clinical trials (ePCTs) have the potential to accelerate the translation of evidencebased interventions into clinical practice. Methods: The mission of the National Institute on Aging (NIA) IMPACT Collaboratory is to build the nation’s capacity to conduct pragmatic clinical trials of nonpharmacologic interventions embedded within health care systems for PWD and their caregivers. Through 6 administrative and management teams and 10 working group cores, IMPACT aims to develop and disseminate best practice research methods, support the design and conduct of pragmatic trials (including funding of pilot studies), build investigator
capacity through training and knowledge generation, catalyze collaboration among stakeholders including health care providers and investigators, and ensure culturally tailored interventions and engagement of people from diverse and underrepresented backgrounds. Results: Leveraging the success of the collaboratory, IMPACT will develop the necessary support and resources specific to the unique needs of PWD and their caregivers. People living with dementia receive care across a spectrum of settings, including not just medical systems but their places of residence and programs to support remaining at home. Each of these settings has its own challenges to implementing ePCTs in this population. Conclusion: The NIA IMPACT health care systems core is building a national resource devoted to the intersection which they receive health care. Our group seeks to engage investigators and sites within the HCSRN and other health systems to establish a collaborative to support and facilitate the conduct of ePCTs among PWD and their caregivers.