Challenges and Opportunities in Implementing a Multicomponent Dementia Caregiver Program in a Complex Healthcare...

Area of Science:

• Gerontology and Aging Research
• Healthcare Systems Implementation Science
• Dementia Care Interventions

Background:

• The Tailored Activity Program (TAP) is an evidence-based practice (EBP) proven to reduce behavioral symptoms in people living with dementia (PLWD) and caregiver burden.
• Despite its efficacy, TAP has not yet been implemented at scale within healthcare systems.
• The Department of Veterans Affairs (VA) Age-Friendly Health System (AFHS) initiative presents an opportunity to test TAP implementation in a complex environment.

Purpose of the Study:

• To explore pre-implementation factors influencing the adoption of the Tailored Activity Program (TAP) within the VA healthcare system.
• To identify critical determinants for successfully integrating TAP into existing clinical workflows and organizational priorities.
• To inform strategies for scaling up EBPs for PLWD and their caregivers within age-friendly health systems.

Main Methods:

• Conducted semi-structured pre-implementation interviews with leaders and clinicians across 6 VA Medical Centers (VAMCs).
• Utilized team-based rapid qualitative analysis to identify themes related to implementation determinants.
• Interviewed 65 unique informants, including VAMC leaders, department leaders, and frontline clinical staff.

Main Results:

• Four key factors emerged as critical for TAP implementation: alignment with organizational priorities, perceived value and workflow fit, competition with existing priorities, and caregiver burden considerations.
• These factors highlight the complexities of integrating multicomponent interventions into established healthcare systems.
• Successful implementation hinges on addressing these determinants proactively.

Conclusions:

• Understanding identified implementation factors is crucial for clinicians, leaders, and scientists planning to scale EBPs like TAP.
• These findings can guide the successful integration and sustainment of interventions supporting PLWD and caregivers within AFHS initiatives.
• Proactive planning based on these determinants can enhance the reach and impact of dementia care interventions.