Mini‐Cog acceptance and conversion rate in Medicare beneficiaries in the primary care

Abstract

AbstractBackgroundAssessing patients for cognitive impairment is a required element of Medicare’s Annual Wellness Visit (AWV). Variability exist in the type of cognitive assessment methods used to assess patients for cognitive impairment during such visits. Paper and pencil tests such as the Mini‐Cog are commonly used in such visits, as they are easy to administer and interpret. Our study aims to assess acceptance of Mini‐Cog use in primary care and conversion of Mini‐Cog from normal to abnormal in the older adults visiting primary care for repeat AWV.MethodsCleveland Clinic implanted Mini‐Cog as a cognitive screening tool in Primary Care Institute in 2019. Inclusion criteria were Age 65+, AWV, no preexisting diagnosis of dementia, normal Mini‐Cog in previous year. Since this process was established, primary care providers were educated about use of Mini‐Cog by internal continuous quality improvement (CQI) platform. Use of Mini‐Cog in AWV within the Primary Care Institute was registered during the study period from January 2021 ‐ December 2022. The number of repeated tests, the rates of conversion of normal (3‐5) to abnormal (0‐2) and the total proportion of abnormal scores overall were recorded.ResultsTotal number of Mini‐Cog during the study period was 46094 out of which 2843 (6.2%) were abnormal.16644 were repeat tests and out of these 507 were abnormal suggesting a 3% conversion rate when testing was repeated on previously normal subjects. An upward trend and 1.7 fold increase was observed in the total number of tests on year to year basis (2021 vs 2022). (Figure 1)ConclusionCurrently, variability exists in the type of cognitive assessments methods used during the AWV in primary care. Consistent use of Mini‐Cog combined with CQI over the period of two years have shown to increase usability and acceptance within Primary Care community. As the repeat assessment have increase over period of time; now we have the opportunity to identify a narrow subset of converted patient (3%) who could benefit from urgent comprehensive cognitive assessment to confirm a diagnosis of dementia and can subsequently close examination of the risk factors that could have contributed to measurable cognitive decline.