Effect of COVID‐19 and telehealth implementation on Patient Centered Outcome Measures completion by patients with Alzheimer’s and related disorders in an academic memory center

Abstract

AbstractBackgroundPatient Centered Outcome Measures (PCOMs) are increasingly recognized as a means of improving clinical efficiency, particularly when completed electronically ahead of clinic visits. However, PCOM completion is often far from consistent. The shift to telehealth introduced by the Covid‐19 pandemic changed how patients and caregivers engaged with medical care, possibly encouraging increased participation in electronic assessments. We questioned how the pandemic influenced electronic PCOM completion by our patients with Alzheimer’s disease (AD) and their caregivers.MethodsPatients and caregivers were routinely invited to fill electronic PCOM questionnaires prior to visits both before and during the Covid‐19 pandemic. PCOMs assessed the predominant cognitive domain of concern, other diagnostically useful symptoms, disease severity, neuropsychiatric symptoms, and caregiver wellbeing. A date of 3/15/2020 was set as the onset of the pandemic for this study, after which time our clinic converted to telehealth visits only. We tallied rates of completion of electronic surveys by patients and/or caregivers three and a half months before and after that time, comparing completion rates by two proportion Z‐test.ResultsDuring this timeframe, across a total of 402 visits (total: 333 individuals, 69 returns; AD: 73 individuals, 6 returns), caregivers and/or patients were offered an opportunity to fill PCOMs ahead of the visit. Across all clinical diagnoses combined, the probability of a visit being associated with filled PCOMS was greater after switching to only telehealth (caregivers: P = 0.005, patients: P = 0.016). Additionally, after the shift to telehealth, AD‐related visits were twice as likely to have completed preclinical electronic PCOMs (caregivers: P = 0.002, patients: P = 0.008). Approximately 33.3% of PCOMS to be filled by AD caregivers were completed before the telehealth shift, and 67.5% were afterwards. Approximately 26.7% of patient PCOMs were filled before the change, and afterwards this percentage rose to 55.0%.ConclusionThe beginning of the Covid‐19 pandemic and subsequent shift towards telehealth‐only practice was associated with greater use of electronic PCOMs by all patients, including those with AD and their caregivers. Increased acceptance of electronic PCOMs seems to offer promising opportunities for remote assessment in the future of dementia diagnosis and care.