Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoidable emergency de- partment (ED) visits and hospitalizations. Adult day service centers (ADCs) provide community-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily assessment and serial observations by an ADC’s interdisciplinary staff (which includes registered nurses, social workers, and program directors) support early detection of clinical problems in PLWD. However, when acute changes in health status occur, ADC staff who wish to provide timely notification to primary care providers (PCPs) frequently cannot do so effectively. In my prior research, I found that ADC staff relied on facsimile or voicemail message to com- municate urgent information. This resulted in delayed or non-responses from PCPs and allowed minor health issues to escalate into medical emergencies. As the number of PLWD in ADCs grows, there is a critical need to strengthen communication of salient clinical information between ADCs, PCPs, and caregivers to reduce costly hospitalizations and ED visits. Mobile health (mHealth) interventions have been shown to improve com- munication and clinical information exchange across a variety of health care settings, but they have not been designed for ADCs. My goal in seeking a K23 award is to become an independent scientist who leads a re- search program that integrates care from ADCs and PCPs using mHealth interventions to reduce avoidable health care utilization disparities in PLWD. With support from an experienced interdisciplinary mentorship team, I will acquire training in three areas: using integrated health systems to address health care utilization disparities, developing mHealth interventions using user-centered design principles, and designing and testing behavioral interventions. With the requisite training, I will execute the following specific aims: (1) Identify patient and caregiver reported warning signs that can be integrated into an mhealth application in order to address emerging clinical problems and distressing symptoms among PLWD in ADCs; (2) design and test the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and informal care- givers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth application use among ADC staff, PCPs, and informal caregivers in reducing hospitalizations and ED visits in PLWD over a 6- month period. My findings will inform a future R01 proposal to test the efficacy of an intervention using a fully operational mHealth application. This study is significant because the findings will be used to improve stand- ards of care and reduce costly and traumatic outcomes in PLWD. It also advances legislation from the Office of the National Coordinator for Health Information Technology requiring that patients be able to access infor- mation from their medical records using their preferred smartphone application. This study is innovative be- cause it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the development of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.

Project Narrative. Inefficient communication among providers and caregivers of community-dwelling persons living with dementia (PLWD) can allow minor health issues to escalate into medical emergencies, resulting in increased hospitalizations, emergency department visits, and significant costs to health systems. The proposed application supports the Principal Investigator in acquiring requisite training to inform the development and preliminary testing of a user-centered mobile health (mHealth) application that facilitates communication among adult day service centers, caregivers, and primary care providers around the needs of PLWD. In doing so, this study works toward national goals of reducing fragmentation in health care delivery, optimizing care quality and efficiency, and expanding support for PLWD and their families, especially those in diverse communities.