Applying Implementation Frameworks to Health IT Development in Dementia Care: Lessons from the CareHeroes Project

Abstract

AbstractBackgroundCaregiving and clinical care for people living with dementia (PLWD) is complex and complicated by communication challenges among caregivers and providers (Gaugler et al., 2022; Ruggiano et al. 2012; 2019). These challenges can constrain decision making about treatment options (Hinton et al., 2007; Miller et al., 2016; Wolff et al., 2020) and may contribute to negative mental health outcomes often reported by family caregivers (Gaugler et al., 2022), which disproportionately impact vulnerable caregivers (e.g., underserved racial/ethnic groups, rural caregivers (Abner et al., 2016; Fabius et al., 2020)). Health information technology (HIT) has been identified as a potential solution to communication challenges in dementia care (Ruggiano et al., 2019; Vedel et al., 2013). However, few studies have reported how to effectively integrate new HIT into practice to support provider‐caregiver communication. In this study, a four‐stage implementation science framework (Meyers et al., 2012) was used to integrate a newly developed web‐based application (app) technology, called CareHeroes (Brown et al., 2016), into clinical practice at two memory clinics to promote caregiver‐physician communication. CareHeroes is multi‐functional and allows secure sharing of patient‐related clinical information between caregivers and providers. It also provides education and support, including an educational chatbot that provides tailored, expert feedback to caregiver questions.MethodEarly stages of implementation involved interviews with caregivers and focus groups with clinic providers to develop a clinical workflow integration plan for the new app. Then, the research team collected user data collected through the app during implementation as well as caregiver psychosocial outcome data (e.g., depression, burden) at baseline and 3‐month follow‐up to evaluate implementation.ResultThirty‐six caregivers and eight clinic providers provided qualitative data that informed the clinical workflow integration plan. The same providers and 21 additional caregivers enrolled in the CareHeroes implementation demonstration study. While user data demonstrated that it was feasible for caregivers to share clinical information and engage in self‐support using CareHeroes, expected outcomes were confounded by complications during the COVID‐19 pandemic.ConclusionThrough using the implementation framework, several lessons were learned regarding potential success and challenges in integrating new HIT into clinical care to support dementia care and caregiving.