"It's Hard to Connect the Dots Sometimes, but at Least We Have Dots": A Qualitative Study of Dementia Care in a Large Integrated Health Care System.

BACKGROUND: Providing high-quality 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. PARTICIPANTS AND SETTING: Clinicians involved in dementia care within the Veterans Affairs (VA) health care system. METHODS: Between August 2024 and July 2025, we conducted semi-structured 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-level matrices and compared dementia care practices, challenges, and improvement strategies across key domains. RESULTS: 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- and home-based primary care teams, a national caregiver support program, facility-level 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. CONCLUSIONS: 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- and system-level improvements through intentional use of shared infrastructure to facilitate cross-site learning, disseminate effective strategies across sites, and tailor interventions to local needs.