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DementiaNCT05849259

Caring for Caregivers and People Living With Dementia Under Home-Based Primary Care

A study testing Dementia Care Quality at Home in people with Dementia and Quality of Life, run by Massachusetts General Hospital at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this clinical trial is to develop a dementia care intervention for persons receiving home-based primary care (HBPC) and living with dementia (PLWD) and their caregivers, and test the feasibility of implementing the intervention in HBPC practices to ultimately improve outcomes of PLWD and their caregivers. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Dementia, Quality of Life, Caregiver Stress
What is being tested?
Dementia Care Quality at Home
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
2 sitesUnited States
Study dates
16 Oct 2023to 20 Dec 2024
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Caregiver participants will:
  • be adults (18 years or older)
  • have English fluency and literacy
  • live in the United States
  • live with and care for an individual with Alzheimer's Disease and Alzheimer's Disease Related Dementias (ADRD)
  • anticipate providing care for the next 6 months
Show all 12Show fewer
  • provide an average 4 hours of supervision or direct assistance per day for the care recipient and
  • have been identified by the practice as experiencing caregiver stress.
  • Staff participants will:
  • be 18 years or older
  • have English fluency and literacy and live in the United States and
  • be part of a HBPC primary care program or closely connected to the practice.

Who cannot join

  • Participants under the age 18.
  • Participants who have no English fluency and literacy and do not live in the United States.
  • For caregiver participants, not caring for and living with a patient that is part of a HBPC primary care program or closely connected to the practice.

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • Queens Medical Center

    Honolulu, Hawaii, 96813

  • Virginia Commonwealth University

    Richmond, Virginia, 23219

Other trials in United States

About this study

The goal of this clinical trial is to develop a dementia care intervention for persons receiving home-based primary care (HBPC) and living with dementia (PLWD) and their caregivers, and test the feasibility of implementing the intervention in HBPC practices to ultimately improve outcomes of PLWD and their caregivers.

The main aims are to:

Read more
  • Develop and refine HBPC Dementia Care Quality at Home
  • Establish feasibility (primary outcome), acceptability, and fidelity of HBPC Dementia Care Quality at Home through an open-pilot trial involving two HBPC practices. Trained clinicians and staff at two HBPC practices will implement the intervention

Relevant stakeholders (caregivers of PLWD, and HBPC clinicians and staff) will participate in qualitative focus groups to provide feedback on the intervention.

Read the detailed description

The overarching goal of this project is to develop a dementia care intervention for PLWD and their caregivers, Dementia Care Quality at Home, and test the feasibility of implementing the intervention in two HBPC practices to ultimately improve outcomes of PLWD and their caregivers.

The investigators will evaluate the feasibility, acceptability, and fidelity in implementing HBPC Dementia Care Quality at Home in two practices for persons living with dementia and their caregivers through an open pilot. Hypothesis: HBPC Dementia Care Quality at Home will meet benchmarks of feasibility, acceptability, and fidelity by the HBPC practices implementing it and by caregivers of PLWD who experience the intervention. The investigators will assess feasibility of caregivers of PLWD to engage with the intervention, the acceptability of the intervention to caregivers, and the impact of the intervention on caregiver well-being by surveying caregivers at the conclusion of the pilot. In addition, the investigators will assess feasibility, acceptability, and fidelity of the intervention in the practices.

Being tested
Dementia Care Quality at Home
Medical subject headings
Dementia, Caregiver Burden

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Dementia Care Quality at HomeOther

    Each of the two HBPC practices will identify at least two trained Dementia Care Quality at Home Champions who will be trained in the intervention comprised of 1) a standardized assessment tool to assess PLWD and caregiver needs; 2) six modules created to optimize the well-being of the PLWD and their caregiver; and 3) regular team-based review of persons participating in the program to address care challenges and a team-based case conference approach to solve these challenges.

Study groups in NCT05849259
Study groupRoleWhat they receive
Dementia Care Quality at HomeExperimentalCaregivers across two HBPC practices receive the Dementia Care Quality at Home intervention.
Receives: Other: Dementia Care Quality at Home

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility for the Caregiver to Engage With and Complete Baseline Assessments.

    The percentage of identified caregivers who complete baseline assessments.

    Measured: Baseline

  2. Feasibility for the Caregiver to Access Educational Materials and Community Resources.

    Percent of caregivers will report using 1 or more materials provided by the practice.

    Measured: Post-intervention (6 months)

  3. Feasibility for the Practice of Identifying Potential Patients/Caregivers

    Ability of practice to generate list of their patients living with dementia using a questionnaire to the practice

    Measured: Baseline

  4. Feasibility for the Practice of Assessing Eligible Patient/Caregiver Dyads.

    Ability of practice to identify eligible patient/caregiver dyads (e.g., caregiver experiencing burden or distress).

    Measured: Baseline

  5. Feasibility for the Practice to Use Baseline Assessments.

    Percent of practice personnel who conduct assessments that rate assessments as feasible to use

    Measured: Post-intervention (6 months)

  6. Feasibility for the Practice to Complete Baseline Assessments

    The percent of audited assessments that are completed.

    Measured: Post-intervention (6 months)

Secondary outcomes (9)
  1. Feasibility for the Practice of Recruiting Patient/Caregiver Dyads

    Percentage of eligible dyads who enroll.

    Measured: Pre-intervention

  2. Patient Quality of Life

    Quality of Life in Alzheimer's Disease. The QoL-AD is comprised of 13 items (physical health, energy, mood, living situation, memory, family, marriage, friends, self as a whole, ability to do chores, ability to do things for fun, money and life as a whole). Response options include 1(poor), 2(fair), 3(good) and 4 (excellent), for a total score of 13-52, with higher scores indicating better QoL.

    Measured: Pre-Intervention (baseline) and post-intervention (6 months)

  3. Heard and Understood

    A one-item measure of caregivers who report that they felt heard and understood by the practice.

    Measured: Post Intervention (6 months)

  4. Caregivers - Net Promoter Score of Intervention

    The single question - "How likely are you to recommend X to a friend [or colleague]?" is rated from 0 - Not at all likely to 10 - Extremely likely.

    Measured: Post-intervention (6 months)

  5. Feasibility for the Practice to Use Care Modules.

    The percentage that rates modules as feasible to use. The percentage of practice personnel who complete the modules that rate the modules as feasible to use

    Measured: Post-intervention (6 months)

  6. Feasibility for the Practice to Complete Care Modules

    Percent of audited modules that are completed.

    Measured: Post Intervention (6-months)

  7. Feasibility for the Practice of Clinicians to Engage With the Tele-video Case Conference.

    % of case conferences conducted with at least one staff member present from each site

    Measured: Post-intervention (6 months)

  8. Acceptability of the Intervention to Caregivers to Participate in the Intervention.

    Percent of caregivers invited to participate who agree to participate in the intervention.

    Measured: Pre-intervention (baseline)

  9. Feasibility for the Practice of Percent of Racial and Ethnic Minorities Recruited.

    Percentage of eligible dyads who enroll who are racial and ethnic minorities.

    Measured: Pre-intervention (baseline)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 May 2023
  2. Study start16 Oct 2023
  3. Primary completion31 Oct 2024
  4. Study completion20 Dec 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Not applicable
Intervention model
Single group
Model description
A live open-pilot trial will be conducted of the HBPC Dementia Care Quality at Home intervention in two HBPC practices.
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05849259
Sponsor's protocol ID
2022P003057
Status last verified
Sep 2025
First submitted
7 Apr 2023
Last updated
25 Sep 2025
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Leff B, Ritchie C, Freeland DG, Jamshed N, Major A, Gallopyn N, Sharieff S, Taylor J, Yudin JA, Sheehan OC. The National Home-Based Primary Care Learning Network: A Practice-Based Quality Improvement and Research Network. J Am Med Dir Assoc. 2022 Aug;23(8):1424-1426. doi: 10.1016/j.jamda.2022.02.017. Epub 2022 Mar 26.

    PubMed 35351444
  • Foakes G, Hurt C, Lehner JL, Tinsley H, Valentine J, Doede DD, Ritchie C, Leff B. Using Registry Data to Support National Quality Forum Endorsement of Quality Measures for Home-Based Medical Care. Am J Med Qual. 2021 Nov-Dec 01;36(6):402-407. doi: 10.1097/01.JMQ.0000735496.32223.40.

    PubMed 33990472
  • Yang M, Pajewski N, Espeland M, Easterling D, Williamson JD. Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults. BMC Geriatr. 2021 Oct 18;21(1):561. doi: 10.1186/s12877-021-02506-1.

    PubMed 34663232
  • Reckrey JM, Yang M, Kinosian B, Bollens-Lund E, Leff B, Ritchie C, Ornstein K. Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare. Health Aff (Millwood). 2020 Aug;39(8):1289-1296. doi: 10.1377/hlthaff.2019.01537.

    PubMed 32744949
  • Ornstein KA, Leff B, Covinsky KE, Ritchie CS, Federman AD, Roberts L, Kelley AS, Siu AL, Szanton SL. Epidemiology of the Homebound Population in the United States. JAMA Intern Med. 2015 Jul;175(7):1180-6. doi: 10.1001/jamainternmed.2015.1849.

    PubMed 26010119
  • Nguyen HQ, Vallejo JD, Macias M, Shiffman MG, Rosen R, Mowry V, Omotunde O, Hong B, Liu IA, Borson S. A mixed-methods evaluation of home-based primary care in dementia within an integrated system. J Am Geriatr Soc. 2022 Apr;70(4):1136-1146. doi: 10.1111/jgs.17627. Epub 2021 Dec 22.

    PubMed 34936090
  • Sorensen S, Conwell Y. Issues in dementia caregiving: effects on mental and physical health, intervention strategies, and research needs. Am J Geriatr Psychiatry. 2011 Jun;19(6):491-6. doi: 10.1097/JGP.0b013e31821c0e6e. No abstract available.

    PubMed 21502853
  • Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009;11(2):217-28. doi: 10.31887/DCNS.2009.11.2/hbrodaty.

    PubMed 19585957
  • Chiao CY, Wu HS, Hsiao CY. Caregiver burden for informal caregivers of patients with dementia: A systematic review. Int Nurs Rev. 2015 Sep;62(3):340-50. doi: 10.1111/inr.12194. Epub 2015 Jun 8.

    PubMed 26058542
  • Li L, Wister AV, Mitchell B. Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging. J Gerontol B Psychol Sci Soc Sci. 2021 Aug 13;76(7):1415-1429. doi: 10.1093/geronb/gbaa197.

    PubMed 33170276
  • Schulz R, O'Brien AT, Bookwala J, Fleissner K. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist. 1995 Dec;35(6):771-91. doi: 10.1093/geront/35.6.771.

    PubMed 8557205
  • Heintz H, Monette P, Epstein-Lubow G, Smith L, Rowlett S, Forester BP. Emerging Collaborative Care Models for Dementia Care in the Primary Care Setting: A Narrative Review. Am J Geriatr Psychiatry. 2020 Mar;28(3):320-330. doi: 10.1016/j.jagp.2019.07.015. Epub 2019 Aug 2.

    PubMed 31466897
  • Tanner JA, Black BS, Johnston D, Hess E, Leoutsakos JM, Gitlin LN, Rabins PV, Lyketsos CG, Samus QM. A randomized controlled trial of a community-based dementia care coordination intervention: effects of MIND at Home on caregiver outcomes. Am J Geriatr Psychiatry. 2015 Apr;23(4):391-402. doi: 10.1016/j.jagp.2014.08.002. Epub 2014 Aug 13.

    PubMed 25260557
  • Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, Hooper SM, Allen IE, Braley T, Bernstein A, Rosa TD, Harrison K, Begert-Hellings H, Kornak J, Kahn JG, Naasan G, Lanata S, Clark AM, Chodos A, Gearhart R, Ritchie C, Miller BL. Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use: The Care Ecosystem Randomized Clinical Trial. JAMA Intern Med. 2019 Dec 1;179(12):1658-1667. doi: 10.1001/jamainternmed.2019.4101.

    PubMed 31566651
  • Arora S, Thornton K, Murata G, Deming P, Kalishman S, Dion D, Parish B, Burke T, Pak W, Dunkelberg J, Kistin M, Brown J, Jenkusky S, Komaromy M, Qualls C. Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011 Jun 9;364(23):2199-207. doi: 10.1056/NEJMoa1009370. Epub 2011 Jun 1.

    PubMed 21631316

Questions about this trial

What is this clinical trial studying?

A study testing Dementia Care Quality at Home in people with Dementia and Quality of Life, run by Massachusetts General Hospital at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 25 Sep 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility for the Caregiver to Engage With and Complete Baseline Assessments. (time frame: Baseline). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05849259, which also lists 32 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Sep 2025.

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