Integrating Serious Illness Care into Primary Care Delivery for persons with dementia: CARIÑOS En Su Casa – Care for you at home

Abstract

AbstractBackgroundThe patient‐centered medical home (PCMH) as a model of primary care transformation has the potential to improve the quality, safety, and efficiency of care and reduce costs, particularly during the COVID‐19 pandemic for persons with dementia. However, the effects of adopting the PCMH are lack of clinical and economic support, let alone the challenge of applying it in ethnically and culturally diverse patient populations.MethodTo address the limitations of the traditional PCMH model, the CARIÑOS approach, a patient‐driven, comprehensive, coordinated, and multi‐site care model, was developed by the University of Texas (UT) Health San Antonio Geriatrics and Supportive Care Practice to meet the healthcare needs of patients in an underserved, primarily Hispanic community, who are often frail and have complex medical and care needs between various healthcare settings. Early outcomes on costs were collected to demonstrate its economic effects.ResultOverall, the implementation of the CARIÑOS approach reduced total costs per patient per year by comparing six practices affiliated to the UT Health San Antonio Accountable Care Organization (ACO) – Regional Physicians Network. They serve similar underserved areas in the first and second Quarters of 2021. After adopting the CARIÑOS approach ($45,705), the costs were lower than 4 out of the 6 ACOs practices. In comparison, the Hierarchical Condition Category (HCC) score of the patients seen at the Geriatrics and Supportive Care Practice (HCC = 1.45) was higher than those seen at the other six practices (average = 1.15) during the same period of 2021.ConclusionThe CARIÑOS approach provides an innovative and comprehensive perspective delivering culturally congruent care for persons with dementia and support for their families.The main learning objectives of the session will be1. To enlist the elements of the CARINOS Approach for person centered care.2. To describe strategies that can be used to implement this approach in dementia care of underserved and Hispanic families.3. List the ways to engage promotores or community health workers as a bridge between the healthcare team and patient and family to improve patient experience.Key words – person centered, dementia care