(Ongoing) 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 providing the PRO-MADE team with implementation research expertise on the qualitative evaluation of PRO-MADE’s implementation and outcomes.

Lead: Dr Tan Woan Shin (Deputy Executive Director 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 evaluate the implementation of the PRO-MADE model into the Next Generation Electronic Medical Records system at TTSH. GERI is the implementation research partner on this project, leading the qualitative evaluation of PRO MADE’s implementation and outcomes. Previously, GERI funded the development and validation of the PRO-MADE tool which formed the foundation for its ongoing deployment and evaluation.

Anticipated Impact: PRO-MADE’s integration into the NGEMR allowed 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 admitted to the Geriatric and General Medicine departments in TTSH. GERI’s research has guided the development of implementation strategies to address implementation barriers, and will provide insights on integrating clinical and electronic workflows to support future implementation of similar predictive models as part of clinical care. The study protocol has been published in BMC Geriatrics, with future publications planned.

Funding: Temasek Foundation

Duration: Jul 2023 to Jun 2026