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NIH grant 1R01AG103433-01: Did the Guiding an Improved Dementia Experience (GUIDE) Model Improve Outcomes for Rural Medicare Beneficiaries?
Institute: {'code': 'AG', 'abbreviation': 'NIA', 'name': 'National Institute on Aging', 'admin_org_id': '12500002', 'admin_funding_url': ''}. PI: Karen Ellen Joynt Maddox. Award: $649496.
Start: 2026-09-05T00:00:00.
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.document fetched 2026-09-10 22:51