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Did the Guiding an Improved Dementia Experience (GUIDE) Model Improve Outcomes for Rural Medicare Beneficiaries?

Award Number: R01AG103433
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/05/2026
PERIOD OF PERFORMANCE END DATE: 04/30/2031

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Did the Guiding an Improved Dementia Experience (GUIDE) Model Improve Outcomes for Rural Medicare Beneficiaries? - SUMMARY Alzheimer’s Disease (AD) and AD-related dementias (ADRD) are progressive neurological conditions. Rural individuals with AD/ADRD are diagnosed at later stages, have less access to specialty care, higher use of nursing facilities and lower use of home health care, and worse outcomes than their urban counterparts. Finding ways to improve care and outcomes for people living with this disease in rural areas is a priority. One potential approach to improving AD/ADRD care is through payment mechanisms that incent care redesign to provide more holistic and patient-centered programs. Guiding an Improved Dementia Experience (GUIDE) is a new Medicare payment program – the first with an explicit focus on dementia – that reimburses dementia care programs (DCPs) that provide comprehensive care coordination, training programs for unpaid caregivers, and respite care. The GUIDE model could be particularly advantageous for rural people living with dementia. Providing enhanced payment to local organizations and respite for caregivers, via partnerships embedded in local communities with knowledge of unique challenges in rural areas, could be a key source of care for the aging rural population with AD/ADRD. Quantifying the impact of GUIDE, on rural communities in particular, is critically important as Medicare and other payers increasingly shift towards these and other related alternative payment models. Our aims in this proposal are as follows: Aim 1: Compare GUIDE participants to non-participating practices on beneficiary, practice, and organization-level characteristics at program launch and over time. Aim 2: Use within-beneficiary analyses to determine if GUIDE is associated with improvements in access, quality, and outcomes, overall and among rural beneficiaries. Aim 3: Use key informant semi-structured interviews and implementation science frameworks to identify barriers to and actionable facilitators for GUIDE participation, practice engagement, and quality improvement in rural areas. This work will provide timely information to inform ongoing updates to GUIDE, and to elucidate ways in which its implementation could be further optimized in rural areas. Our quantitative and qualitative findings will generate actionable recommendations that could be directly used by clinical leaders to enhance care offerings for aging rural Medicare beneficiaries, or used to develop evidence-based interventions for rural caregivers hoping to participate in novel payment or care delivery programs. This work will help to maximize the likelihood that GUIDE will have meaningful positive impact for rural adults with AD/ADRD.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $649,496 )
2026	2026	WASHINGTON UNIVERSITY, THE	1 BROOKINGS DR	SAINT LOUIS	MO	63130	SAINT LOUIS	USA	Aging Research	000	1	9/4/2026	NEW	$649,496
														Subtotal = $649,496

Grand Total All Awards = $649,496

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Did the Guiding an Improved Dementia Experience (GUIDE) Model Improve Outcomes for Rural Medicare Beneficiaries?

Award Number: R01AG103433

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/05/2026

PERIOD OF PERFORMANCE END DATE: 04/30/2031

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