Education, digital tools, and diagnostic support to increase PCP‐based cognitive testing in patients 65 years and older

Abstract

AbstractIn the United States, primary care clinicians (PCPs) typically diagnose and treat most patients who have or who may be developing neurocognitive disorders (NCDs). However, as many as two‐thirds of patients remain underdiagnosed, misdiagnosed or experience a delay in the diagnosis. Many barriers to care have been cited for these failures in diagnosis, including PCP limitations in time and expertise, as well as inadequate technical, financial, and staffing resources. Diagnostic delays may particularly impact minority populations, exacerbating the disparate burden these communities bear from dementing disorders. In contrast, an early diagnosis is an impetus to advanced care planning, to strategizing for patient safety, and to initiating interventions that may preserve cognitive function and enhance quality of life.The main objective for this proposal is to increase the rate of cognitive screening in patients 65 years and older. PCP practices that serve diverse communities are early implementation sites. This proposal focuses on addressing barriers to testing by providing PCPs with educational resources to enhance the efficiency and quality of care for patients with neurocognitive disorders. The goal is to educate PCPs on the importance of early cognitive screening and to provide tools to help manage their patients with cognitive disorders and dementia more efficiently. Primary care providers are offered multiple educational and practice supports for managing patients who have an abnormal cognitive screen. The BrainCheck digital cognitive testing tool allows clinical support staff to rapidly test patients for cognitive impairment. Educational tools include succinct didactic lectures; a SharePoint site that serves as a resource hub for and weekly Project ECHO® based Memory Care Case Conferences (CME provided). EHR tools include simple order sets and templates. The practice support tool is an implementation of eConsults to quickly link PCPs to dementia experts in order to answer questions about patient care.The outcomes of this project measured in terms of PCP feedback, cognitive testing gains, educational participation, and tool usage will allow us to design more effective strategies for increasing cognitive testing and improving the management of patients with dementia at the health system level.