Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer’s disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors’ administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.

The need for person- and relationship-centered care (PCC/RCC) in Alzheimer’s disease and other dementias is well established. Recognizing the limitations of PCC in fully honoring the intricate interdependencies between care partners and persons living with dementia, a new training program called Bravo Zulu was developed. This comprehensive, 12-hour dementia training program aims to enhance personhood beliefs and self-efficacy among care partners, improving the experience of care and support for both people living with dementia and their care partners. Responses from 182 participants who completed the training were analyzed using paired t-tests to assess changes in personhood beliefs and self-efficacy. The Bravo Zulu training produced significant increases in both personhood beliefs and self-efficacy. Notably, healthcare professionals without prior care partner training exhibited the greatest gains in personhood beliefs, while participants who were not direct care partners showed substantial improvements in self-efficacy. Overall, these findings support the concept of tailoring dementia education to ensure care partners and healthcare professionals are able to provide culturally competent care that is aligned with the diverse backgrounds of people living with dementia. Expanding access to high-quality interactive programs such as Bravo Zulu can contribute to strengthening the dementia care workforce and improving care experiences for all involved.

Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two Geriatrics Workforce Enhancement Programs delivered training to primary care providers on using telehealth to provide ACP. Using electronic health records data from 6344 dual-eligible Medicare/Medicaid patients receiving telehealth primary care from trained providers in an urban safety net system, persons living with dementia (n = 401) were identified by extracting ICD-10 codes. The primary outcome was the estimated hospitalization-associated cost, with a key independent variable of ACP billing status. Multiple linear regressions and machine learning techniques estimated the impact of telehealth ACP on hospitalization-associated costs with a differential analysis by race. Compared to non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40. Costs for non-English speakers or those having increased comorbidities were higher by USD 27,346.60 and USD 26,072.70, respectively. Overall, receiving ACP was associated with lower costs of USD 23,928.84. Dementia patients seen by primary care providers in a system receiving training to offer ACP via telehealth realized significant cost savings, with marked differences among those of non-White racial backgrounds.

Beliefs about personhood held by healthcare professionals and care partners influence care outcomes, satisfaction, and the well-being of persons living with dementia (PLWD). This study examined differences in personhood beliefs based on demographic and contextual factors, including the Social Vulnerability Index (SVI), using registration data from the Bravo Zulu care partner training program (n = 540). Guided by the Ring Theory of Personhood, eight factors were analyzed: age, sex, race, socioeconomic status, professional discipline, healthcare experience, prior care partner training, and SVI. One-way ANOVA and independent t-tests were used to examine group-level differences, and multiple linear regression was conducted to assess the extent to which these factors predicted personhood beliefs. Race, age (borderline significance) professional discipline, and prior training as a care partner were significant predictors of personhood beliefs. Subscale analyses using ANOVA and t-test showed that beliefs about psychosocial engagement varied by SVI and healthcare experience with small effect size; however, these factors did not significantly predict of overall personhood beliefs in the regression model. Findings underscore the importance of recognizing how background characteristics shape personhood beliefs about PLWD. Promoting self-reflection and expanding culturally responsive training may support person- and relationship-centered care and improve satisfaction in multicultural care settings.

Appreciative Inquiry models identify diverse ways that AI initiatives may commence. Our Partnerships in Dementia Care Alliance AI early phase experience required a focus on key underlying relational processes, work that we call ‘Dawn,’ before we could begin. We identify and demonstrate these relational processes with examples from the PiDC Alliance culture change work on improving dementia care in diverse long-term and community healthcare settings.