Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design
Abstract Background People with dementia receive differential access to palliative care services despite suffering from a significant burden of the disease in the advanced stage. Professional and familial caregivers may not view dementia as a terminal illness and are less likely to engage in end-of-...
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BMC
2025-05-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05955-0 |
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| author | Allyn Hum Palvinder Kaur Wen Yang Goh Riyin Tay Han Yee Neo Mervyn Yong Hwang Koh Noorhazlina Binte Ali Wee Shiong Lim Yu-Ling Jackie Tan Huei Yaw Wu Palvannan Kannapiran Hwee Teng Robyn Tan Yan Sun Chin Ee Ong Ravinder Singh Sachdev Zhi Jun Low Lee Hung Tey Woan Shin Tan Yew Yoong Ding |
| author_facet | Allyn Hum Palvinder Kaur Wen Yang Goh Riyin Tay Han Yee Neo Mervyn Yong Hwang Koh Noorhazlina Binte Ali Wee Shiong Lim Yu-Ling Jackie Tan Huei Yaw Wu Palvannan Kannapiran Hwee Teng Robyn Tan Yan Sun Chin Ee Ong Ravinder Singh Sachdev Zhi Jun Low Lee Hung Tey Woan Shin Tan Yew Yoong Ding |
| author_sort | Allyn Hum |
| collection | DOAJ |
| description | Abstract Background People with dementia receive differential access to palliative care services despite suffering from a significant burden of the disease in the advanced stage. Professional and familial caregivers may not view dementia as a terminal illness and are less likely to engage in end-of-life care discussions. Healthcare providers also face challenges coordinating palliative care in the community for dementia, demonstrating a lack of understanding of the needs of patients living with advanced dementia, and resources available to support them within the community. Aim The aim of this study is to implement a transmural model of care in a tertiary care setting where patients living with advanced dementia (PLAD) at risk of deterioration in one year are identified early to receive tailored palliative care interventions using a predictive algorithm. Methods/Design The updated medical research council (MRC) framework for complex interventions is used to guide the development and implementation of the transmural model which incorporates a predictive algorithm in clinical practice, with interventions tailored for at risk PLAD both within, and beyond the tertiary care setting. The PROgnostic Model for Advanced DEmentia (PRO-MADE) developed to predict one-year all-cause mortality in PLAD presenting to an acute care hospital was embedded into the electronic health records of the tertiary care setting as a mathematical equation. Predictive modeling markup language in the digital records platform is used to calculate the risk score for PLAD by inputting the predictors. The clinical team is alerted of at risk PLAD through timed directive prompts, with advice on management given through tailored care bundles. The study will adopt a mixed methods approach in a Type 1 effectiveness-implementation study design to concurrently study the effectiveness of the transmural model in practice, and the barriers and facilitators to its implementation. Conclusion The implementation of a transmural model of early palliative care for patients with advanced dementia requires the coordination between clinicians in the tertiary care setting and community, together with health information technologists. This study protocol describes its development and implementation, and the study design to evaluate its outcomes. |
| format | Article |
| id | doaj-art-98ab253e01b542069a4fedfb42f6daab |
| institution | OA Journals |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj-art-98ab253e01b542069a4fedfb42f6daab2025-08-20T02:10:50ZengBMCBMC Geriatrics1471-23182025-05-0125111010.1186/s12877-025-05955-0Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study designAllyn Hum0Palvinder Kaur1Wen Yang Goh2Riyin Tay3Han Yee Neo4Mervyn Yong Hwang Koh5Noorhazlina Binte Ali6Wee Shiong Lim7Yu-Ling Jackie Tan8Huei Yaw Wu9Palvannan Kannapiran10Hwee Teng Robyn Tan11Yan Sun12Chin Ee Ong13Ravinder Singh Sachdev14Zhi Jun Low15Lee Hung Tey16Woan Shin Tan17Yew Yoong Ding18Department of Palliative Medicine, Tan Tock Seng HospitalHealth Services and Outcomes Research, National Healthcare GroupDepartment of Palliative Medicine, Tan Tock Seng HospitalPalliative Care Centre for Excellence in Research and EducationDepartment of Palliative Medicine, Tan Tock Seng HospitalPalliative Care Centre for Excellence in Research and EducationDepartment of Geriatric Medicine, Tan Tock Seng HospitalDepartment of Geriatric Medicine, Tan Tock Seng HospitalDepartment of General Medicine, Tan Tock Seng HospitalPalliative Care Centre for Excellence in Research and EducationHealth Services and Outcomes Research, National Healthcare GroupInstitute of Policy Studies, National University of SingaporeHealth Services and Outcomes Research, National Healthcare GroupDepartment of Palliative Medicine, Tan Tock Seng HospitalDepartment of Clinical & Health Informatics Office, Tan Tock Seng HospitalDepartment of Palliative Medicine, Tan Tock Seng HospitalDepartment of Palliative Medicine, Tan Tock Seng HospitalGeriatric Education & Research InstituteGeriatric Education & Research InstituteAbstract Background People with dementia receive differential access to palliative care services despite suffering from a significant burden of the disease in the advanced stage. Professional and familial caregivers may not view dementia as a terminal illness and are less likely to engage in end-of-life care discussions. Healthcare providers also face challenges coordinating palliative care in the community for dementia, demonstrating a lack of understanding of the needs of patients living with advanced dementia, and resources available to support them within the community. Aim The aim of this study is to implement a transmural model of care in a tertiary care setting where patients living with advanced dementia (PLAD) at risk of deterioration in one year are identified early to receive tailored palliative care interventions using a predictive algorithm. Methods/Design The updated medical research council (MRC) framework for complex interventions is used to guide the development and implementation of the transmural model which incorporates a predictive algorithm in clinical practice, with interventions tailored for at risk PLAD both within, and beyond the tertiary care setting. The PROgnostic Model for Advanced DEmentia (PRO-MADE) developed to predict one-year all-cause mortality in PLAD presenting to an acute care hospital was embedded into the electronic health records of the tertiary care setting as a mathematical equation. Predictive modeling markup language in the digital records platform is used to calculate the risk score for PLAD by inputting the predictors. The clinical team is alerted of at risk PLAD through timed directive prompts, with advice on management given through tailored care bundles. The study will adopt a mixed methods approach in a Type 1 effectiveness-implementation study design to concurrently study the effectiveness of the transmural model in practice, and the barriers and facilitators to its implementation. Conclusion The implementation of a transmural model of early palliative care for patients with advanced dementia requires the coordination between clinicians in the tertiary care setting and community, together with health information technologists. This study protocol describes its development and implementation, and the study design to evaluate its outcomes.https://doi.org/10.1186/s12877-025-05955-0Advanced dementiaPredictive algorithmTransmuralEarly palliative careImplementation |
| spellingShingle | Allyn Hum Palvinder Kaur Wen Yang Goh Riyin Tay Han Yee Neo Mervyn Yong Hwang Koh Noorhazlina Binte Ali Wee Shiong Lim Yu-Ling Jackie Tan Huei Yaw Wu Palvannan Kannapiran Hwee Teng Robyn Tan Yan Sun Chin Ee Ong Ravinder Singh Sachdev Zhi Jun Low Lee Hung Tey Woan Shin Tan Yew Yoong Ding Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design BMC Geriatrics Advanced dementia Predictive algorithm Transmural Early palliative care Implementation |
| title | Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design |
| title_full | Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design |
| title_fullStr | Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design |
| title_full_unstemmed | Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design |
| title_short | Implementing a transmural model of early palliative care in advanced dementia: the use of a hybrid effectiveness-implementation study design |
| title_sort | implementing a transmural model of early palliative care in advanced dementia the use of a hybrid effectiveness implementation study design |
| topic | Advanced dementia Predictive algorithm Transmural Early palliative care Implementation |
| url | https://doi.org/10.1186/s12877-025-05955-0 |
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