Which team approach works best for Alzheimer’s patients in nursing homes?

USC’s Natalie Leland and a team of researchers will begin comparing the effectiveness of two different approaches to treating Alzheimer’s and dementia patents in nursing homes.

The $4.7 million research project will be funded by the Patient-Centered Outcomes Research Institute. Its mission is to fund research that provides patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.

More than half of America’s 1.4 million nursing home residents have Alzheimer’s disease or dementia. Leland, an associate professor at the USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, will examine the two main models for how health care services are delivered in nursing homes:

• The multidisciplinary model, in which each provider treats patients pretty much independently of other providers.
• The interdisciplinary model, which has a much more team-based approach among providers because care is more coordinated by a physician or a nurse practitioner.

We know that both models have been independently shown to yield benefits. We’re just not sure which is more effective and under what circumstances.

Natalie Leland

“We know that both models have been independently shown to yield benefits,” Leland said. “We’re just not sure which is more effective and under what circumstances.”

During the five-year project, Leland and the team will randomly implement one of the two approaches at 80 nursing home facilities across the United States. Collaborators will include additional researchers at USC, Thomas Jefferson University and the University of Pittsburgh, as well as a diverse advisory committee.

The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.

Medication comparison

Leland, an occupational therapist and gerontology researcher who also holds a joint faculty appointment at the USC Davis School of Gerontology, will be looking at differences between the models with respect to the amount of off-label antipsychotic medications given to residents, their disruptive behavior and the impact on residents, staff and families.

“Transforming the quality of dementia care in America’s nursing homes is fundamentally about improving quality of life for patients, their families and their advocates,” Leland said.

Patient-Centered Outcomes Research Institute is an independent, nonprofit organization authorized by Congress in 2010. Results published by institute-sponsored studies often influence reimbursement and coverage decisions made by Medicare and other insurers.