Home Based Primary Care for Persons Living with Dementia: Nurse Practitioner Teams and Outcomes

About one million Persons Living With Dementia (PLWD) are homebound and have difficulty accessing office‐ based primary and specialty care. They often unnecessarily use emergency departments and hospitals which result in poor health outcomes. Home based primary care (HBPC) brings care directly to the homes of PLWD’s and meets their needs. Yet, its wide-scale implementation is challenged by physician workforce shortages. Nurse practitioners (NPs) are increasingly utilized in HBPC and are the dominant HBPC provider. To care for homebound PLWD, NPs not only deliver direct care but also lead the HBPC team and coordinate home- and community-based services. NP-HBPC teams structures vary and may include dieticians, social workers, pharmacists, aides, mental health providers, and others. To date little is known about the composition of effective NP-HBPC teams. Also, how team members communicate, share advice, or help to deliver care to PLWD or how the resulting social networks affect outcomes have not been studied. We will combine analysis of team configurations and social networks in NP-HBPC teams with assessment of NP workforce outcomes to identify team best practices. We will collect qualitative data to assess the underlying teamwork dynamics not captured quantitatively. The specific aims are: Aim 1. Identify team composition and social networks of NP- HBPC teams caring for PLWD. Aim 2. Examine the relationship between NP-HBPC team composition and social networks and NP job satisfaction, burnout, and turnover intention. Aim 3. Identify barriers, facilitators, and characteristics of teamwork in NP-HBPC teams with different team compositions and social network connections. Using social network methods, we will survey HBPC NPs (n=350) caring for PLWD in New York state. We will send mail surveys, along with web links, to ask NPs to identify their team members and report the connections between team members (i.e., communication, advice, trust, support, and problem-solving). NPs will also report on their job satisfaction, burnout, and turnover. ORA* and R software will be used for data analysis. We will map team configurations and social networks, visualize them, and compute network metrics. We will use Quadratic Assignment Procedure to predict factors explaining networks and regression models to test the relationships between team and social network measures and NP outcomes to identify the best team and network structures for favorable job outcomes. Based on Aim 1, we will recruit NPs from highly- (n~20) and poorly- (n~20) connected social networks for individual interviews. Content analysis of the data will identify themes. Quantitative and qualitative findings will be triangulated to inform efforts to leverage the NP-HBPC workforce to care for homebound PLWD and design teams to facilitate communication and information transfer, improve the quality of life for PLWD and caregivers, and maintain the wellbeing and functioning of the HBPC NP workforce. This application is in response to Notice of Special Interest (NOT-AG-20-026): Dementia Care Workforce for Those Living with Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias.