Implementing and sustaining dementia care coordinators across integrated care systems: a realist evaluation

Area of Science:

• Healthcare Services Research
• Public Health Policy
• Geriatric Care Management

Background:

• Global dementia care faces significant strain due to rising prevalence and system pressures.
• UK government prioritizes dementia care transformation, implementing new support services within integrated care systems (ICS).
• Limited understanding exists regarding the operational dynamics of these novel dementia support services.

Purpose of the Study:

• To evaluate the functioning of a dementia care coordinator service within England's largest integrated care system (ICS).
• To identify how the service impacts people living with dementia, their carers, and the healthcare workforce.
• To understand the mechanisms and contexts influencing the service's effectiveness.

Main Methods:

• A realist evaluation employing mixed methods was conducted from 2022 to 2024.
• Data collection included a repeat survey of dementia care coordinators and 57 interviews with stakeholders.
• Analysis utilized a realist logic framework across all collected data.

Main Results:

• Key concepts identified: workforce design, organizational culture, meeting patient/carer needs, and service integration.
• Twenty-three context-mechanism-outcome configurations (CMOCs) revealed coordinators act as 'bridge builders' connecting individuals to support.
• Potential for service success to be undermined by increasing caseloads and staff burnout.

Conclusions:

• The dementia care coordinator service effectively supports individuals pre- and post-diagnosis, even within a strained system.
• The positive impact is attributed to the 'bridge building' role of the coordinators.
• Findings support evidence-based recommendations for implementing and sustaining system-wide services, advocating for increased national funding.