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Alzheimer’s disease and Dementia (AD) affect 44 million people globally and 5.3 million Americans.  One in eight people over 65 suffer from AD.  In the US alone, the number of patients is expected to grow to 16 million by 2050.  The annual cost is $226 billion growing to $1.1 trillion by 2050.  AD represents the largest drain on health care because, as a group, the cost is three times the average due to long term institutional care, higher utilization of emergency services and more frequent re-admissions.  The prognosis is further exacerbated by a lack of gerontologist.

Aging Brain Care Model

Preferred Population Health Management’s Aging Brain Care (ABC) Model has been called the first true population management program for patients with Alzheimer’s, dementia, severe depression and other forms of brain disease.  Our Healthy Aging Brain Care (HABC) Monitor is the blood pressure cuff for the brain.  Our Aging Brain Care Model is the only population management approach to assess and treat AD and thereby address the other health issues affecting the patient.  The ABC Model is an evidence-based suite of proprietary tools that aid in providing quality care to patients and support for caregivers.  Our Aging Brain Care Model is a Collaborative Care Model that brings together healthcare professionals aided with our tools to lower costs and improve care.  Out tools include our proprietary extended Medical Records software (eMR-ABC), our innovative approach to creating and implementing our MedHome Care model or our Clinic Center model, our full-scale Replication Manuals, Care Protocols, Caregiver Resource Handbook, the HABC Monitor, and the ABC Anticholinergic Cognitive Burden Scale.

Any Organization wishing to use any of these tools must obtain a license from Preferred Population Health Management.
Contact PPHM for Licensing Information
 

Collaborative Care Model

The ABC Collaborative Care Model is the result of a 9-year study resulting in an evidence based model with established protocols that created a high touch/right technology model that lowered costs and improved patient care. The collaboration of the right healthcare professionals, using validated protocols and tools, results in a true triple aim: improved patient outcomes, improved care delivery, and lower costs.

eMR-ABC

Most systems do not collect important data on functional, cognitive, behavioral and psychological symptoms and needs. Indeed, because they rely on ICD-9 codes, most data systems fail to identify 60 to 80 percent of patients with dementia at all.
eMR-ABC is a user-friendly, web-based medical record system designed to work hand in hand with the Aging Brain Care Model.  eMR-ABC is an enhanced electronic medical record, patient registry, tracking and automated decision support system to support care coordination for patients and their caregivers.  eMR-ABC helps clinicians diagnose, evaluate, and manage dementia patients and their caregivers more effectively.  It was specifically developed to capture patient and caregiver demographics, patient ER visits, hospital admissions, depression and cognition tracking, medication adherence, and anticholinergic burden.
eMR-ABC is accessible and designed for users with little to no experience with clinical software applications.  Because patient assessments are translated into electronic format, eMR-ABC can seamlessly connect individual patient’s dementia care plan with the electronic medical records of the clinical practice.

Features
  • Proprietary software
  • Flexible and secure access to platform from multiple locations
  • Solutions to capture self/caregiver-reported  functional, behavioral, psychological, and cognitive symptoms
  • Decision support for delivering personalized pharmacological and non-pharmacological care protocols
  • Capacity for tracking and monitoring patient and caregiver biopsychosocial needs
  • Capable of tracking and monitoring population-based outcomes to guide overall program performance
When it’s installed and fully integrated, eMR-ABC enables the practitioner to:
  • Update patient data
  • Track patient contact and appointments
  • Track biopsychosocial needs over time for both patient and family caregiver
  • Track decision support recommendations
     

MedHome / Clinic Care Model

The ABC Replication Manuals offer a step-by-step guide for any health system or primary care clinic to successfully adopt ABC models. The manuals are available exclusively to health systems and clinics that have contracted with PPHM for Implementation. Integrating a collaborative care model into usual clinical practice is never easy. The ABC MedHome and Clinic Care Replication Manuals were developed, with the help of implementation scientists at Indiana University, to present a logical, practical series of steps to guide the implementation process in a range of settings.

The ABC Replication Manuals outline the discoveries made during the original PREVENT study of dementia care, including its content and the delivery process. This information was translated into the practical, operational ABC Model. (Details on the PREVENT study were published in May 2006 in the Journal of the American Medical Association.) The Manuals contain a step-by-step process by which a health care system or primary care clinic can successfully implement the ABC Model by creating an ABC Med Home or Clinic Care environment. 
The Manual also describes:
 
  • the minimum specifications and materials for adopting the ABC program
  • the care delivery process of ABC
  • logistical and operational details such as staffing, space and IT requirements
 
ABC Care Protocols
The ABC Care Protocols help physicians and other health professionals guide care planning and delivery for patients with dementia or depression and for all patients following an acute care episode.
The acute care utilization protocols, as well as the protocols for patients with diagnoses of dementia and depression, are critical tools after a current or new patient is hospitalized. They are used subsequently to guide clinical discussions and care planning, including both medical acute care and and nonpharmacological care, in a variety of ways. The dementia and depression protocols, for example, may be used to guide the care plan and to determine follow-up by the ABC MedHome team after the first and subsequent visits.
Topics covered in the medical protocols include:
  • Timing and triggers for care, such as MMSE and PHQ9 scores
  • Medication protocols such as cholinesterase inhibitors or memantine
  • Referrals and advanced diagnosis protocols
Topics covered in the non-pharmacological and caregiver protocols include:
  • Legal and financial
  • Physical health including dental care
  • Coping strategies for depression and anxiety, repetitive behavior, aggression and agitation
  • Coping strategies for wandering and shadowing
  • Coping strategies for balance and falls
  • Personal care such as bathing, dressing and meals, toileting and incontinence
  • Coping strategies for sleep disturbance
  • Coping strategies for delusions, hallucinations, paranoia and delirium
  • Protocols targeted to patients with mild cognitive impairment only
Healthy Aging Brain Care Monitor
Improving dementia care requires three key building blocks often lacking in clinical practice. First, a standarized, reliable means of screening to ease the process of finding patients with a high probability of having dementia. Second, an accurate confirmation of the presence of dementia in these screened patients. And third, proper monitoring of the response to dementia-specific, pharmacological and non-pharmacological management plans.
The HABC Monitor is a tool designed to meet all three needs by helping clinicians determine the nature and severity of the patient’s cognitive, functional, and behavioral and psychological problems, as well as the level of caregiver stress.

The HABC Monitor addresses four areas: cognition, functional deficit, behavioral and psychological health, and caregiver burden. There are two versions of the HABC Monitor, one for the patient (for self-reporting) and one the caregiver (for both observations of the patient and self-reporting on the caregiver’s own status).

The HABC Monitor tracks symptoms over time by asking caregivers and patients questions such as, "over the past two weeks, how often did your loved one have problems with:
  • Repeating the same things over and over such as questions or stories
  • Forgetting the correct month or year
  • Handling complicated financial affairs such as balancing checkbook, income taxes & paying bills
  • Planning, preparing, or serving meals
  • Taking medications in the right dose at the right time
  • Walking or physical ambulation
  • Less interest or pleasure in doing things, hobbies or activities
  • Feeling anxious, nervous, tense, fearful or panic
  • Hearing voices, seeing things or talking to people who are not there
  • Wandering, pacing, or doing things repeatedly
    Questions for caregivers include, "over the past two weeks, how often did you have problems with..?"
  • Your quality of life, financial future and physical/mental health
 

Caregiver Resource Handbook

The challenges facing family caregivers are tremendous and are often overlooked by  health care providers. Caregiver health statistics are alarming: one quarter of all Alzheimer’s family caregivers are either hospitalized or need emergency department care every six months. [1]
Quality dementia care must recognize caregiver needs as well as those of the patient. The Aging Brain Care Model comprehensively and systematically addresses both.
The Caregiver Resource Handbook is an accessible and practical reference tool providing useful information and tips for caregivers. The Handbook provides instructions to help the caregiver provided better care to their loved one and to ensure they are maintaining their own personal health and wellness. The instructions help the caregiver successfully manage, reduce, or avoid problem patient behaviors. The Handbook also provides useful background information, a copy of the Anticholinergic Burden Scale to help caregivers understand what prescription and over-the-counter medications should be avoided, and a caregiver version of the HABC Monitor for tracking feelings, events and concerns. The Handbook addresses:
 
  • Memory loss
  • Medications
  • Discussing and tracking AD with others
  • Caregiver self-care, coping skills, exercise and depression
  • Patient communication (verbal and nonverbal)
  • Managing mealtimes, toileting, bathing, dressing, dental care, avoiding falls
  • Problem solving, safety advice, wandering, and delirium
  • Sundowning, paranoia, inappropriate sexual behavior and hallucinations


Anticholinergic Burden Scale

Half of all dementia patients routinely receive drugs that make their symptoms worse. The Anticholinergic Cognitive Burden Scale and the Possible Anticholinergics List identify medications to avoid.
Most physicians realize the common side effects of anticholinergic drugs. What many do not understand, however, is that anticholinergics can exacerbate and even cause symptoms of dementia. Fewer still may recognize the anticholinergic properties of drugs that are new to the market or have indirect anticholinergic properties.
The ABC interdisciplinary team has tackled this issue by developing the Anticholinergic Cognitive Burden scale. This practical tool identifies the prescription and over-the-counter medications and classifies them by the severity of their anticholinergic effects on cognition. It also suggests safer alternative medications. While avoiding all anticholinergics is not always clinically possible, increasing awareness of the most problematic medications is the first step in educating health care providers.

Research has shown that in most health systems, approximately half of all dementia patients routinely receive contraindicated drugs – including painkillers, antihistamines and psychiatric medications —that can make their symptoms worse. This causes needless suffering, drives up health costs, and may even increase mortality.

Widely prescribed drugs with strong negative side effects for the aging brain include:
  • the over-the-counter antihistamine Benadryl
  • the antidepressant Paxil
  • the overactive bladder medication oxybutynin
  • the anti-schizophrenic clozapine
  • the heart drug digoxin
  • the blood thinner warfarin
  • the painkiller codeine
  • the steroid prednisone
 

HABC Monitor Mobile App

The Healthy Aging Brain Care Mobile App (HABC) is appropriate for health professionals and non-clinical family members and caregivers.  This app is three tools in one; used to assess both the patient and the in home caregiver. 

First, the HABC Monitor measures the nature and severity of an Alzheimer/Dementia patient’s cognition, functional deficit, behavioral and psychological health; and it also assess the caregiver’s burden level.  Measurements are displayed in easy to read, color-coded dials relating patient and caregiver condition.

Second, half of all dementia patients routinely receive drugs that make their symptoms worse. This app includes the Anticholinergic Cognitive Burden Scale listing medications to avoid.  This practical tool identifies prescription and over-the-counter medications and classifies them by the severity of their effects on cognition. It also suggests safer, alternative medications.

And third, the HABC Mobile App includes protocols to aid caregivers who must deal with:

  • Managing strategies for depression, anxiety, repetitive behavior, confusion, aggression and agitation.
  • Coping strategies for wandering, shadowing, balance and falls.
  • Personal care such as bathing, dressing, meals, toileting and incontinence.
  • How to address sleep disturbance, delusions, hallucinations, paranoia and delirium. Stress, exercise, communication, physical health and dental care and legal and financial education.
 

Aging Brain Care Program Simulator

Before implementing a collaborative care delivery program, health care leaders want to know are the benefits of the program worth my time, effort, and resources?  Facing a growing aging population with limited resources for providing care, it is important that leadership focuses on the programs that can reap the highest returns, and the greatest rewards.  Our innovative computer simulator allows you to determine the feasibility of the ABC program.  The ABC Simulator can potentially save you valuable time and thousands of dollars in the cost of a traditional feasibility study.  The ABC Simulator provides you with insights into the resources needed to ensure a successful collaborative care program:  financial, human, and technological.  These insights are measured in terms of key performance indicators:  Cost of care, acute care utilization, and program efficiency.  There are 49 variables that we can vary and test multiple factors:  patient characteristics, resource levels, payment models, and care protocols.  Results are simulated in real time and displayed in various charts and graphs.
 
[1] Indiana University Center for Aging Research published in the November 2008 issue of the Journal of General Internal Medicine.
 
 

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