Social Networks in Nurse Practitioner Teams Caring for Patients with Dementia and Impact on Racial and Ethnic Disparities

Currently, 10.7% of Americans aged 65 and older have Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD). By 2050, 14% (12.7 million) will be affected. Racial and ethnic minorities bear uneven burdens; nearly 19% of Black and 14% of Hispanic older adults have AD/ADRD compared to 10% of White older adults. Patients with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) often lack access to high-quality care and have poorer outcomes, such as higher hospital and emergency department (ED) use. While caring for PLWD and eliminating health disparities are national priorities, the current primary care system is ill-prepared, mainly due to primary care physician shortages. Nurse practitioners (NPs), the fastest-growing primary care workforce, who disproportionately care for racial and ethnic minorities, are vital for dementia care. Increasingly, NPs lead team-based care, and primary care models that leverage NP teams can address PLWD disparities. Yet, NP teams are poorly studied, and little is known about which teams deliver the best care. To design high-performing NP teams, it is key to identify members of NP teams (team configuration), understand how team members communicate, seek advice, and share support, and show how these connections (social networks) affect PLWD outcomes. Building on our work on teams, social networks, dementia care, and health disparities, our novel, national mixed-methods study will produce this evidence. Using novel methods, including social network analysis (SNA), positive deviance, and the Delphi technique, we aim to 1. Identify NP team configurations and social networks (i.e., communication, advice, trust, support, and problem-solving) in primary care practices caring for PLWD. 2. Assess how NP team configurations and social networks impact PLWD outcomes (i.e., hospitalizations, ED use) and evaluate racial and ethnic disparities in these outcomes. 3. Identify barriers, facilitators, and characteristics of teamwork in NP teams with different configurations and social networks. 4.Develop and disseminate practice and policy recommendations to design and implement NP teams in primary care practices to care for PLWD and achieve health equity. We will conduct a social network survey of a national sample of NPs caring for PLWD to map their teams using SNA. By merging these data with data on hospital and ED use and applying regression models, we will assess the NP team's impact on PLWD outcomes and racial and ethnic disparities. Using positive deviance, we will interview NPs from variably configured teams (e.g., small, large) and with different networks (e.g., highly, poorly connected) from Aim 1 to understand the context in which NP teams function. We will triangulate findings to design practice and policy recommendations and refine them through Delphi method with a panel of patient advocates, practice leaders, clinicians, and policy experts. Our findings will inform key stakeholders seeking to enhance dementia care delivery and the effectiveness of the dementia workforce. Our application is in response to Notice of Special Interest (NOSI) NOT-AG-21-049 to enhance the Dementia Care Workforce for Those Living with AD/ADRD.