Integration of a PROgnostic Model for Advanced Dementia (PRO-MADe) into tertiary clinical care using the implementation research logic model

Full name: Integration of a PROgnostic Model for Advanced Dementia (PRO-MADE) into tertiary clinical care using the implementation research logic model: A qualitative analysis

GERI's Role: GERI is PRO-MADE’s implementation research partner, providing expertise in the qualitative evaluation of PRO-MADE’s implementation and outcomes. GERI funded the development and validation of the PRO-MADE tool which formed the foundation for its ongoing deployment and evaluation.

Lead: Dr Tan Woan Shin (Deputy Director, Research and Scientist, GERI)

Age Well SG strand: Strengthen support for seniors with care needs in the community

Principal Investigator: Dr Allyn Hum (Adjunct Scientist, GERI; Head and Senior Consultant, Department of Palliative Medicine, Tan Tock Seng Hospital (TTSH))

Gap: Almost 70% of patients with advanced dementia do not receive timely palliative care due to challenges of recognising the terminal phases of end-stage dementia, leading to them dying in hospitals instead of their own homes or appropriate long-term care facilities. While the PRO-MADE prognostication model has been developed to identify patients with advanced dementia who are at high-risk of one-year all-cause mortality, there is a need to integrate the model into routine clinic workflows.

Planned Solution: This project aims to translate and integrate the PRO-MADE model into the electronic medical records system (NGEMR) for widespread use by clinicians in tertiary clinical practice settings at TTSH. GERI is the implementation research partner on this project.

Anticipated Impact: PRO-MADE’s integration into the NGEMR will allow clinical care to extend from tertiary care to their site of discharge in the community, which then allows healthcare providers to prompt the initiation of palliative care plans for deteriorating patients with advanced dementia. GERI’s research will guide the development of implementation strategies for the potential expansion of PRO-MADE into other non-geriatric settings in TTSH, such General Medicine, with potential plans for external validation and scaling up of PRO-MADE. Findings by GERI on identifying implementation strategies will be presented at a scientific conference in June 2025.

Funding: Temasek Foundation

Duration: Jul 2023 to Jun 2026