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Browsing by Author "Morgan, Robert O."

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    A Break-Even Analysis for Dementia Care Collaboration: Partners in Dementia Care
    (Springer, 2015) Morgan, Robert O.; Bass, David M.; Judge, Katherine S.; Liu, C. F.; Wilson, Nancy; Snow, A. Lynn; Pirraglia, Paul; Garcia-Maldonado, Maurilio; Raia, Paul; Fouladi, N. N.; Kunik, Mark E.; University of Texas Health Science Center Houston; University of Texas School Public Health; Cleveland State University; US Department of Veterans Affairs; Veterans Health Administration (VHA); Vet Affairs Puget Sound Health Care System; University of Washington; University of Washington Seattle; Baylor College of Medicine; University of Alabama Tuscaloosa; Providence VA Medical Center; Brown University; Alzheimer's Association
    Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. Study subjects were veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention (N = 269) and three comparison sites (N = 165). PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p a parts per thousand currency signaEuro parts per thousand 0.001), baseline cognitive impairment (p a parts per thousand currency signaEuro parts per thousand 0.05), number of personal care dependencies (p a parts per thousand currency signaEuro parts per thousand 0.01), and VA service priority (p a parts per thousand currency signaEuro parts per thousand 0.01) all predicted change in log total cost. These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination.
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    A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months
    (BMC, 2014) Bass, David M.; Judge, Katherine S.; Snow, A. Lynn; Wilson, Nancy L.; Morgan, Robert O.; Maslow, Katie; Randazzo, Ronda; Moye, Jennifer A.; Odenheimer, Germaine L.; Archambault, Elizabeth; Elbein, Richard; Pirraglia, Paul; Teasdale, Thomas A.; McCarthy, Catherine A.; Looman, Wendy J.; Kunik, Mark E.; Cleveland State University; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); Baylor College of Medicine; University of Texas Health Science Center Houston; University of Texas School Public Health; National Academies of Sciences, Engineering & Medicine; Alzheimer's Association; Harvard University; VA Boston Healthcare System; University of Oklahoma Health Sciences Center; Providence VA Medical Center; Brown University
    Introduction: "Partners in Dementia Care" (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer's Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Methods and Findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = -0.09; p = 0.05), depression (B = -0.10; p = 0.03), and unmet need (B = -0.28; p = 0.02; and B = -0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = -0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = -0.96; p < 0.01) and embarrassment (B = -0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided. Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia.
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    Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program
    (BMC, 2021) Snow, A. Lynn; Loup, Julia; Morgan, Robert O.; Richards, Kathy; Parmelee, Patricia A.; Baier, Rosa R.; McCreedy, Ellen; Frank, Barbara; Brady, Cathie; Fry, Liam; McCullough, Megan; Hartmann, Christine W.; University of Alabama Tuscaloosa; University of Texas Health Science Center Houston; University of Texas School Public Health; University of Texas Austin; Brown University; University of Massachusetts Lowell
    Background: Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents' sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer's disease and or related dementias-almost two-thirds of long-stay nursing home residents-are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods: This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention's sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention's impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program's implementation and sustainability. Discussion: This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study's strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.
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    Teaching Caregivers of Persons with Dementia to Address Pain
    (Elsevier, 2017) Kunik, Mark E.; Snow, A. Lynn; Wilson, Nancy; Amspoker, Amber R.; Sansgiry, Shubhada; Morgan, Robert O.; Ying, Jun; Hersch, Gayle; Stanley, O. T. R. Melinda A.; Baylor College of Medicine; University of Alabama Tuscaloosa; University of Texas Health Science Center Houston; Texas Womans University
    Objectives: To compare the efficacy of Preventing Aggression in Veterans with Dementia (PAVeD) with that of usual care in decreasing incidence of aggression (primary outcome) and pain and improving depression, pleasant events, caregiver burden, and patient-caregiver relationship quality (secondary outcomes). Design: Randomized controlled trial with assessments at baseline and 3, 6, 9, and 12 months Setting: Houston, TX. Participants: A total of 203 community-dwelling veterans with pain and dementia and their caregivers. Intervention: PAVeD, 6 to 8 weekly sessions of 45-minute home visits with masters-level clinicians providing instruction to caregivers on recognizing pain, enhancing communication, and making daily activities pleasant and enjoyable, and at least two elective sessions. Measurements: Cohen-Mansfield Agitation Inventory (primary outcome), Philadelphia Geriatric Pain Intensity Scale, Geriatric Depression Scale, Pleasant Events Schedule-AD, Burden Interview, Mutuality Scale (secondary outcomes), Client Satisfaction Questionnaire. Results: There were no significant differences in aggression incidence between intervention and control groups, although the PAVeD group had significantly better mutuality than controls. Conclusions: PAVeD may need to address a broader range and more in-depth coverage of aggression risk factors with person-centered tailoring to target certain types of distress. Interventions to prevent aggression may also need to address medical providers in addition to caregivers.