Project Summary. Community-dwelling persons living with dementia (PLWD) are highly susceptible to avoida-
ble emergency department (ED) visits and hospitalizations. Adult day service centers (ADCs) provide commu-
nity-based care to a growing number of racially diverse PLWD, the majority of whom are low-income. Daily as-
sessment 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 communicate 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 communication 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 inde-
pendent scientist who leads a research program that integrates care from ADCs and PCPs using mHealth in-
terventions 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 ad-
dress health care utilization disparities, developing mHealth interventions using user-centered design princi-
ples, and designing and testing behavioral interventions. With the requisite training, I will execute the following
specific aims: (1) identify the key domains of an mHealth application intended to support communication be-
tween ADCs, PCPs, and informal caregivers regarding the health-related needs of PLWD; (2) design and test
the visual layout of an mHealth application intended to support communication between ADCs, PCPs, and in-
formal caregivers of PLWD; and (3) develop and examine the feasibility and acceptability of mHealth applica-
tion 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
standards 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
information from their medical records using their preferred smartphone application. This study is innovative
because it leverages ADCs’ strengths and incorporates frontline provider perspectives to inform the develop-
ment of a pragmatic user-centered mHealth application to integrate care and reduce disparities in PLWD.
