Understanding and Addressing Fragmented Care for People Living with Dementia: A Midcareer Mentoring Program - Adults ≥65 years old in the U.S. routinely receive ambulatory care from multiple outpatient providers. Indeed, the proportion of Medicare beneficiaries seeing ≥5 physicians in a year has increased from 19.1% in 2000 to 35.1% in 2019. When ambulatory care becomes so diffuse that no single provider accounts for a substantial proportion (typically, a majority of visits), that pattern of care is considered “fragmented.” Fragmentation of care may be clinically appropriate, but it is hazardous because providers caring for the same patient do not consistently communicate with each other, even in the era of electronic health records. Fragmented care has been associated with missing clinical information, missed or delayed diagnoses, duplicate prescriptions, drug- drug interactions, repeat testing, excess procedures, and excess emergency department visits and hospitalizations. Although fragmentation of care does not only affect people living with dementia (PLWD), this population is particularly vulnerable to its adverse effects. How to address fragmentation for PLWD is unclear. Lisa M. Kern, MD, MPH (PI) is a Professor of Medicine, a primary care physician by training, and a health services researcher with a passion for high-quality ambulatory care for older adults with multiple chronic conditions. Dr. Kern is a leading national expert in understanding and addressing fragmented care, having studied this problem for 10 years. Dr. Kern has been or is currently the sole principal investigator on 8 grants specifically to study patterns of ambulatory care and fragmentation of care, including 2 R01s from NIH, one of which focuses on PLWD and started in September 2024 (R01AG087243). Dr. Kern has experience mentoring trainees, but she has not yet developed a formal training program on fragmentation of care research, and more investigators are needed in this field. Dr. Kern brings expertise in primary care, health services research, and pragmatic trials. To advance this work, she needs formal training to acquire new skills in artificial intelligence (AI) and advance skills in mentoring and leadership. The aims of this K24 proposal are to: 1) develop a mentoring program for early-stage and new investigators on research related to fragmentation of care for PLWD; 2) conduct rigorous research on fragmentation of ambulatory care for PLWD (in part through sharing with mentees the resources of Dr. Kern’s current R01, which involves secondary analysis of three national datasets and a qualitative study with primary data collection); and 3) learn skills in AI, mentorship, and leadership. Dr. Kern has assembled an advisory board that brings expertise in biostatistics, informatics, geriatrics, patient-oriented research, Medicare policy, mentoring, and leadership. Fragmentation of care is pervasive and hazardous for older adults. Yet, it is also modifiable. A new cadre of investigators to address this problem is urgently needed.
