The Role of Visit Audio Recordings in Triadic Dementia Care

PROJECT SUMMARY
One in nine people aged 65 or older in the US lives with Alzheimer's disease (AD) or Alzheimer's disease-related
dementia (ADRD). Patients living with dementia (PLWD) and their care partners rely on primary care clinic visits
for dementia information, management, and community referrals. Quality interpersonal communication is
associated with improved health-related outcomes. Models of triadic interactions purport that information
exchange, rapport, and patient and care partner engagement in goal setting and decision-making are key to
effective interpersonal communication. However, the degree to which effective interpersonal communication is
achieved during triadic visits is unknown, and few interventions to support it exist. Using audio recordings of
clinic visits is a novel, evidence-based strategy with the potential to support triadic interactions, yet its application
is unexplored in dementia. The objective of this proposal is to design an intervention that enhances interpersonal
communication in triadic visits using visit recordings. Applicants will follow the NIH Stage Model to redesign their
visit recording platform, HealthPAL, which leverages natural language processing to structure visit information.
The specific aims are: Aim 1 (Stage 0): Conduct a prospective observational study, with outpatient clinic visits of
200 triads (PLWD/care partner/clinician) audio recorded for 12 months; 1.a. Examine the association between
interpersonal communication in triadic AD/ADRD visits and health-related outcomes; 1.b. Identify barriers and
enablers to interpersonal communication in triadic AD/ADRD visits; Aim 2 (Stage 1A): Adapt HealthPAL to
enhance interpersonal communication in triadic AD/ADRD visits; and Aim 3 (Stage 1B): Demonstrate the
usability, feasibility, acceptability, and potential effectiveness of HealthPAL in AD/ADRD. Applicants hypothesize:
1) Constructs from models of interpersonal communication will be associated with health-related outcomes; 2)
HealthPAL will surpass usability, feasibility and acceptability metrics for dyads and clinicians. In Aim 1 applicants
will use an explanatory sequential mixed methods design. Informed by the Behavior Change Wheel, targets for
behavior change will be identified using quantitative assessment of interpersonal communication during triadic
visits (200 dyads, 3 visits annually; ∼600 visits), supplemented by semi-structured interviews with a purposive
sample of 1a triads (n=42); In Aim 2, we will use participatory design methods (n=60) to redesign HealthPAL
using findings from Aim 1; and in Aim 3 we will use an open label, single-arm, multi-site pilot trial (n=30) to
determine usability, feasibility and acceptability of HealthPAL and gather preliminary data on its impact on
interpersonal communication in triadic AD/ADRD visits. This work is a necessary first step to improving PLWD
triadic care by identifying behaviors that impact interpersonal communication and their associations with health-
related outcomes. The intervention developed, and the extensive data collected, will serve as a powerful
resource that can be leveraged to address other gaps in clinical knowledge related to the care of PLWD.

Grant Number: 5R01AG077113-05
NIH Institute/Center: NIH
Principal Investigator: PAUL BARR