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BACKGROUND/RATIONALE:
Dementia has high public health significance due to its prevalence, adverse impact on patients and caregivers, high economic cost to society and the rapidly expanding numbers of individuals age 65 and older. As the largest provider of geriatric care in the U.S., dementia is particularly relevant to the VHA. However, only a small proportion of patients with dementia are diagnosed early when treatments are most effective and the opportunity for careful life planning remains, in part because of the absence of feasible, well-validated case-finding instruments. Our long-term objective is to improve the care and outcomes of veterans with clinically significant cognitive impairment. The first step towards realizing this objective is to identify feasible, valid case-finding tools for primary care. We will also determine if patient characteristics can be used to target case-finding, describe the current process of care and evaluate the association between cognitive impairment and overall- and dementia-related health care utilization and costs.
OBJECTIVE(S):
Primary Aim: To determine whether brief cognitive screeners perform as well as the longer Modified Mini-Mental Status Exam (3MS) for dementia and cognitive impairment-not dementia (CIND).
Secondary Aim 1: To determine if sociodemographic and clinical characteristics available in the electronic medical record can be used to target individuals for cognitive screening and improve screening accuracy.
Secondary Aim 2: To describe current care for an inception cohort with dementia or cognitive impairment-not dementia (CIND).
Exploratory Aim: To evaluate the association between cognitive impairment and overall- and dementia-related health care utilization and costs.
METHODS:
A random sample of primary care patients age greater than or equal to 65 years will be recruited through administrative data from 3 primary care clinics. Their eligibilty will be confirmed. If eligible, patients will schedule an appointment date where the informed consent and HIPAA authoriztion will be completed followed by the Screening assessment and the Criterion Assessment. The Screening assessment consists of three brief instruments and the standard 15-item 3MS that will be compared to the Criterion Standard interview for dementia. We project 140-200 patients will have dementia, 200-300 CIND, and approximately 600 will be cognitively normal. Instruments will be compared using sensitivity/specificity, likelihood ratios and receiver operating characteristic curves. The emotional impact of screening will be assessed following screening. Clinical and sociodemographic characteristics available in the Computerized Patient Record System, together with cognitive screening results, will be analyzed with logistic regression models to identify risk factors that may be used to target individuals for cognitive screening and/or improve screening accuracy. Care patterns for patients with dementia and CIND will be described based on detailed chart abstractions. For the exploratory analysis on cognitive impairment and utilization, two-part utilization models will be estimated for each utilization type, outpatient clinic visits, inpatient visits, pharmacy utilization, and other utilization types; utilization data will be obtained from the DSS.
FINDINGS/RESULTS:
Recruiting began on 5/17/06 and continues. No analysis has been conducted.
IMPACT:
This study will identify feasible and valid case-finding tools for primary care. We will determine if patient characteristics can be used to target case-finding, describe the current process of care and evaluate the association between cognitive impairment and overall- and dementia-related health care utilization and costs. We hope to improve the care and outcomes of veterans with clinically significant instruments.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes, Health Services and Systems
DRE:
Diagnosis and Prognosis, Quality of Care
Keywords:
Dementia, Practice patterns, Utilization patterns
MeSH Terms:
none
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