{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:05:03Z","timestamp":1789632303763,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["HX003424\u201001A1"],"award-info":[{"award-number":["HX003424\u201001A1"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["SDR 02\u2010237"],"award-info":[{"award-number":["SDR 02\u2010237"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["SDR 98\u2010004"],"award-info":[{"award-number":["SDR 98\u2010004"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Providing high\u2010quality care to the growing number of people with dementia in the United States is increasingly challenging. Integrated health care systems may improve care delivery; however, little is known about how dementia care is delivered in this setting. This qualitative study sought to better understand how dementia care is delivered across a large integrated system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and Setting<\/jats:title>\n                    <jats:p>Clinicians involved in dementia care within the Veterans Affairs (VA) health care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between August 2024 and July 2025, we conducted semi\u2010structured interviews with clinicians at VA facilities to compare dementia care practices across a large integrated health care system and identify strengths, challenges, and improvement strategies. We purposefully selected VA facilities to capture variation in facility size, rurality, racial diversity, and geography. Using rapid qualitative analysis methods, we summarized findings in facility\u2010level matrices and compared dementia care practices, challenges, and improvement strategies across key domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed interview data from 28 clinicians across diverse clinical roles (e.g., social workers, psychologists, geriatricians, neurologists) from 6 VA facilities. Participants endorsed numerous strengths of the integrated care system, including interdisciplinary clinic\u2010 and home\u2010based primary care teams, a national caregiver support program, facility\u2010level dementia committees, and unified electronic health records and communication channels. Despite these strengths, participants also identified several challenges and potential strategies to improve care within four key domains: (1) dementia screening and diagnosis; (2) staff training and education; (3) care pathways; and (4) access to services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite some notable advantages, clinicians at participating VA facilities faced several common challenges in dementia care delivery, suggesting that integration alone may not automatically translate into improved care. However, integrated health systems may be well positioned to advance facility\u2010 and system\u2010level improvements through intentional use of shared infrastructure to facilitate cross\u2010site learning, disseminate effective strategies across sites, and tailor interventions to local needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70698","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T07:30:58Z","timestamp":1789630258000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cIt's Hard to Connect the Dots Sometimes, but at Least We Have Dots\u201d: A Qualitative Study of Dementia Care in a Large Integrated Health Care System"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8331-3560","authenticated-orcid":false,"given":"Hannah","family":"Ratliff","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0373-8882","authenticated-orcid":false,"given":"Danielle","family":"Helminski","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2977-4179","authenticated-orcid":false,"given":"Charity M.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Turnwald","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Henry","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-2640","authenticated-orcid":false,"given":"Donovan T.","family":"Maust","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Michigan  Ann Arbor Michigan USA"},{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Krein","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Institute for Healthcare Policy and Innovation, University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Internal Medicine, Division of General Medicine University of Michigan Medical School  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19105"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12362"},{"key":"e_1_2_12_4_1","first-page":"e71345","volume-title":"Alzheimer's Disease Facts and Figures","author":"Alzheimers Association","year":"2026"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2217\/nmt.14.47"},{"key":"e_1_2_12_6_1","unstructured":"Alzheimers Association Alzheimer's Association Highlights Unique Challenges That Dementia Caregivers Face and Tips for Supporting Them. Alzheimer's Association(2023) https:\/\/www.alz.org\/news\/2023\/alzheimers\u2010association\u2010highlights\u2010unique\u2010challenges\u2010that\u2010dementia\u2010caregivers\u2010face\u2010and\u2010tips\u2010for\u2010supp."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591\u2010024\u201003340\u20109"},{"key":"e_1_2_12_8_1","first-page":"4","volume-title":"Integrated Care Models: An Overview","author":"World Health Organization","year":"2016"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/07317115.2025.2505577"},{"key":"e_1_2_12_10_1","unstructured":"Veterans Health Administration VA.gov|Veterans Affairs https:\/\/www.va.gov\/health\/aboutvha.asp."},{"key":"e_1_2_12_11_1","volume-title":"Statistical Projects of All Types of Dementia for VA Patients, VA Enrollees, and US Veterans: Fiscal Years 2021 and 2033","author":"Office of the Assistant Deputy Under Secretary for Health for Policy and Planning","year":"2013"},{"key":"e_1_2_12_12_1","unstructured":"Veterans Health Administration Chief Strategy Office VHA Geriatrics and Extended Care Survey. 2025(2024) https:\/\/vaww.va.gov\/HAIG\/GEC2024\/GEC_Final_Report_For_Posting.pdf."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M16\u20100551"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_12_15_1","unstructured":"NIH Putting the Puzzle Together: Leveraging Dual Use to Improve Care for Veterans Living With Dementia. 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