Implementation Settings and Patients Engaged (Phases 1 and 2)
| Clinician (n) | Care team | Delivery setting | Setting | Implementation timing | Patients (n) |
|---|---|---|---|---|---|
| Phase 1 | |||||
| Social worker (1) | Midsize (<$1 billion), not-for-profit US health system home health team | Telephone | Southeast United States, rural | Independent of home visit with social worker to discuss social needs only | 10 |
| Senior PCP (1) | Private, independent physician (single provider practice) | In-person, in assisted living setting | Midwest United States, rural | During medical visit with physician | 8 |
| Palliative care physician (1) | Midsize (<$1 billion), not-for-profit US health system palliative care team | In-person, palliative care clinic room | Southeast United States, rural | During medical visit with physician | 4 |
| Employed neurohospitalist (1) | Midsize (<$1 billion), not-for-profit US neurohospitalist team | Hospital room | Southeast United States, rural | During medical visit with physician, discharge planner, and researcher | 3 |
| Social worker (1) | Not-for-profit independent area on aging agency | Telephone | Midwest United States, rural | Independent of home visit to ensure understanding of patient’s social needs | 10 |
| PACE PCP (1; identical to phase 2) | Program of all-inclusive care for elderly | PACE care facility | Midwest United States, rural | Patients completed About Me Care Card with administrator before visit with PCP, then discussed card with PCP during medical encounter | 10 |
| Employed PCP (1) | Large (≥$1 billion), not-for-profit US health system | Skilled nursing facility | Midwest United States, small city | During medical visit with PCP | 6 |
| Phase 1 total | 51 | ||||
| Phase 2 | |||||
| PACE PCP (1; identical to phase 1) | Program of all-inclusive care for elderly | PACE care facility | Midwest United States, rural | Patients completed About Me Care Card with administrator before visit with PCP, then discussed card with PCP during medical encounter | 7 |
| Social worker (1) | Midsize (<$1 billion), not-for-profit US social care team, inpatient visit | Part of Hospital Elder Life program | Southeast United States, rural | Social worker conversation with inpatient | 5 |
| Nurse practitioner (1) | Private, independent memory clinic | Telehealth and in-person visits with patients in nursing homes | Midwest United States, rural | During visit with patients via telehealth or in person to specifically assess for cognitive, memory care | 10 |
| Employed PCP (1) | Midsize (<$1 billion), not-for-profit US primary care team | Primary care clinic | Southeast United States, rural | Patient asked to complete About Me Care Card when arriving at clinic, immediately before visiting with PCP; PCP discussed card with patient during medical encounter | 51 |
| Employed PCPs and nurse practitioners (3) | Midsize (<$1 billion), not-for-profit US primary care team | Primary care clinic | Southeast United States, rural | Patient asked to complete About Me Care Card when arriving at clinic, immediately before visiting with PCP; PCP discussed card with patient during medical encounter | 16 |
| Employed neurologist (1) | Memory clinic/institute | Academic tertiary hospital | Madrid, Spain (large city) | Patient asked to complete About Me Care Card when arriving at clinic, immediately before visiting with neurologist; neurologist discussed card with patient during medical encounter | 5 |
| Phase 2 total Overall total | 94 145 | ||||
PACE = Program of All-inclusive Care for the Elderly; PCP = primary care physician.