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Introduction: Rearrangements in primary care are needed to cope with aging populations, resulting in an increased prevalence of dementia and increasing health care costs. An essential strategy to establish a sustainable health care system for people with dementia is implementing integrated care in primary care settings. With DementiaNet, an integrated network-based approach, we facilitated collaboration between healthcare professionals from medical, care and social domains, and helped increasing their dementia expertise. Our aim is to evaluate the effects of the DementiaNet approach on quality of care, network collaboration and number of crisis admissions. Theory/Methods: In a longitudinal mixed methods multiple case study, 34 primary care networks participated; they adopted the DementiaNet approach in which a two-year tailor-made program was offered. Networks started between 2015 and 2020 and follow-up ended in 2021. Yearly, networks participated in data collection on their self-reported quality of care and crisis situations. Network collaboration was assessed yearly with scores on the eight integration domains of the Rainbow Model of Integrated Care based on semi-structured interviews with network leader(s). Descriptive statistics were used to identify changes in mean scores over time. Network characteristics and interview data was used to gain deeper understanding of the quantitative outcomes. Linear mixed models will be used to analyze the differences over time for quality of care and network collaboration. Results: Networks consisted on average of nine professionals (mainly a general practitioner, community nurse, practice nurse and case manager). Follow-up was 2-6 years. On average, quality of care of the networks increased for all measured indicators, of which the percentage of people discussed in a multidisciplinary meeting increased the most from 55% (range 0-100%) to 80% (range 48-100%). Advanced networks had less crisis situations compared to starting networks, 25% versus 30% (p=0.038) of their caseload of persons with dementia had a crisis situation. The quality of care was not associated with the number of crisis situations. Network collaboration increased as well over time and these results sustained or further improved after the two-year program ended. Conclusions: The DementiaNet approach improved quality of care and network collaboration and decreased the number of crisis situations of local primary dementia care networks. These effects sustained after the two-year program ended. Because of the improved collaboration, more advanced networks may be able to better communicate and act sooner in case of an oncoming crisis. Implications for applicability/transferability, sustainability, and limitations: Evaluation of a complex program such as DementiaNet requires an innovative design, flexibility and time. Previous studies did not find improvements after implementing integrated care, we showed that these improvements take at least two years to establish. Nevertheless, these effects were successfully sustained by the networks after the two years of support. Data is partly self-reported by network members. Despite the detailed data-collection protocols and definitions that were provided, the quality of the data may have suffered because of this strategy. Future research should focus on identifying if the DementiaNet approach is able to decrease healthcare costs. [ABSTRACT FROM AUTHOR]

Introduction Crisis admissions of persons with dementia are more prevalent due to the rising number of people with dementia living longer at home. Moreover, societal dependency on informal care grows, which negatively impacts caregivers' wellbeing. This is often a direct reason for crisis admission of the person with dementia. Therefore, we developed REMIND, a digital tool for frequent monitoring of wellbeing and resilience of caregivers, which enables case managers to provide timely support, thereby preventing deterioration in caregiver wellbeing and eventually crisis admissions. The aim of this pilot study is to explore the usability and acceptability of REMIND. Theory/Methods During a 3-month period case manager-caregiver duo's used REMIND. The monitor was developed in co-creation with end-users during focus groups. The pilot version of REMIND consisted of a weekly set of questions on social support, reciprocity, burden, wellbeing, own activities and small crises, filled in via a chat on a smartphone or computer. Caregiver wellbeing was displayed in graphs on a dashboard for case managers to act upon. Usability and acceptability of the tool were explored in semi-structured interviews with the caregivers and case managers. Two independent researchers applied content analysis on the transcripts. Results Eight case managers and fourteen caregivers participating considered the tool easy to use. Caregivers appreciated REMIND, because it stimulated self-reflection regarding the burden of their caregiving processes. Case managers valued the tool's ability to gain better insight in the actual wellbeing of caregivers, because some caregivers find it hard to acknowledge themselves being burdened during a face-to-face conversation. The fact that REMIND provided insight in wellbeing patterns over time instead of a single assessment during a monthly home visit, was highly appreciated by case managers. The monitor outcomes were therefore considered a suitable starting point for conversations with caregivers. Suggestions for improvements included, more diverse set of questions and additional functions including peers support. Discussions In this pilot, REMIND was found highly usable and acceptable for both caregivers and casemanagers. The use a co-design approach in the development likely contributed to these findings. Conclusions Pilot evaluation of digital monitor for caregivers and case managers showed that the tool was easy to use and stimulated self-reflection in caregivers. For case managers it provided a starting point for conversations. The tool is able to monitor wellbeing of caregivers and thereby has the potential to prevent crisis. Lessons learned Developing a monitoring tool for caregivers of persons with dementia in a co-creation design process with end-users led to a well-accepted and easy-to-use device. Limitations Casemanagers in this pilot study were early adopters. Further research should include a more diverse group of case managers. Suggestions for future research A future randomized controlled study with longer follow-up may determine whether its use prevents (small) crises. [ABSTRACT FROM AUTHOR]