Increasing Cognitive Evaluations in Primary Care: Implementing the GSA KAER Model at a Large Healthcare System

Abstract

AbstractThere is widespread recognition that patients with Alzheimer’s disease and related dementias (ADRD) receive better care if they receive an earlier diagnosis. In 2022, the Alzheimer’s Association published a survey of primary care providers (PCPs) indicating that a large majority agree that making an early diagnosis of ADRD is important. However, more than half of PCPs said that they lack the knowledge and confidence to assist in making such a diagnosis.Starting in 2021, the University of Washington launched the Cognition in Primary Care Program to meet that need. Developed with funding from the Centers for Disease Control and Prevention, as an adaptation of the Gerontological Society of America’s KAER Toolkit, the primary goals of the Cognition in Primary Care Program are to increase cognitive evaluations by PCPs and to increase the number of patients diagnosed with ADRD and mild cognitive impairment (MCI).Using practical training modules for PCPs with concise, evidence‐based checklists embedded in the electronic health record (EHR), the program has now been widely adopted by PCPs in a wide variety of clinics serving diverse populations of patients. Evaluations by PCPs describe the program as being of high quality and relevant to their practice. Results on the General Practitioners’ Attitude and Confidence Scale for Dementia (GPACS‐D) six months after the intervention show confidence in evaluating cognition. In addition, the number of MoCA tests uploaded to the EHR increased from 2.7 per month to 5.8 per month, and there was high utilization of the EHR checklist tools. Preliminary data also show that the number of visits in which PCPs have billed a diagnosis of MCI increased from 7.5 per month to 14.4 per month.The strengths of the Cognition in Primary Care Program include its emphasis on actions that PCPs can take to promote brain health and the implementation of innovative EHR tools which PCPs can use in their clinical practice. The Cognition in Primary Care Program is an effective model, shown to be acceptable to PCPs, easy to integrate into a large health system, and successful at increasing cognitive evaluations in the primary care setting.