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Henry Ford Health SystemDementia Screening for Senior Patients
Picker awards established in 2003
Independent nonprofit Patient-centered care Improvement of patient’s
experience and interaction with health care providers
Picker Surveys are the world standard for measuring performance “through the patient’s eyes”
“Understanding and respecting patients’ values, preferences, and expressed needs is the foundation of patient-centered care” Harvey Picker
Founder 1915-
2008
World Health Organization Significant threat to health of all nations First chronic disease to be cited
Dementia as Chronic Disease Genetic vulnerability & environmental exposure Importance of risk factor modification
▪ Disease modification National Alzheimer’s Association
Pre-dementia states▪ Mild Cognitive impairment▪ Pre-clinical AD
Earliest stages are target of treatment National Alzheimer’s Project Grant Medicare Wellness Visit
Patients must be asked about cognition at an annual visit
If the costs of AD were a world economy, it would rank as the 13th largest
AD
Dispel the mythology of memory loss with aging “Normal” age related cognitive decline is not normal
Make the Diagnosis Alzheimer’s Disease? Lewy Body Disease? Frontal Dementia?
Care vs Cure Disease modification strategies Family as patient Community Alliances
Current norms outdated MCI Preclinical changes
Neuropsych tests change late in course NP testing normal in
brains with AD changes Normal NP test does not
mean brain is normal Second to last
biomarker to change
New treatments target preclinical states Biomarkers and risk
factor identification Serial testing (within
subjects) more powerful to predict pathology ▪ Need office easy to
administer office based tool▪ Repeat regularly as part of
health maintenance
Lack of time for assessment
Uncertainty regarding diagnostics
Complexity of cognitive testing
Lack of resources for management of behavioral and social issues, community resources, caregiver training
Henry Ford Hospital
Routine dementia screening annually, starting at age 70
Internet tools for cognitive and behavioral assessments
Identify a specific dementia syndrome
Provide appropriate medical and non-medical treatments
Align patient and caregiver with network of community supports
NIH Toolbox
Public domain web-based assessments Computerized 30 minutes Scoring and interpretationOversight by support personnelIdentifies MCI, AD, non-AD
NeuroQual
Behavior assessmentCaregiver distress
Accessed through CarePlusGuides diagnostic history, physical exam, tests, and treatment Identifies red flags for referralDirect link on CarePlus for Neurology referral if needed
EducationBehavior
managementCommunity referrals
All are referredDirect link on careplus
Located at HFH
Grosfeld Collaborative
June 1-Sept 30Development
Refine web based toolsInterpretive componentDesignate space in each clinic for testingPurchase computersIT issuesPatient advisory groupIdentify 2 primary care clinics for pilotDevelop physician training CDsHire social workerDesignate space for social workerOutcomes measures designated
Oct 1-Nov 30Training
Physician Support personnelSocial workersMeet with advisory group
Dec 1-Feb 28Pilot
Every patient >/= 70 screened in 2 clinicsDatabase collectionMeet with advisory group
Mar 1-May 31Evaluation
Computerized screen for patients >/=70Screening labsMRI (or CT) brainSpecific diagnosisCholinesterase inhibitor for AD or DLBDocumentation of social work outreach call/conferenceMeet with advisory group
Physician History Medications
▪ Anticholinergic burden reduction
▪ Sedative reduction
Targeted neuro exam Objective Tests Treatment
▪ Medical▪ Nonmedical
Reduce Vascular Risk Driving
Social Work Stage dependent learning
series Care management Day respite Area Agency on Aging
referral Support group Behavior management Sleep guidelines Meals on wheels Referral for Financial
PlanningMedical AssistantComputerized cognitive testComputerized behavioral assessmentCaregiver distress/burden
Patient satisfactionDiagnosesUse of dementia medicationsPhysician satisfaction
Any health care organization or practitioner with EMR can utilize this new process Organization must
refine/adapt NIH toolbox with interpretative component
There is a guideline/template for primary care physicians
There is a social work template
Alzheimer’s association chapters exist in all 50 states All chapters can adopt the
reimbursement model for their social workers
Training modules on CDs to be shared with other institutions
Matching funds Siemens Microsoft Pfizer/Eisai
No cost to maintain templates in Careplus once created/modified
No proprietary costs to utilize NIH toolbox
Alzheimer’s social workers can bill for services
Physicians are more likely to adopt age specific screening when testing is Standardized Interpreted Performed by a
technician Reimbursement
commensurate with complexity of visit
How the topic is framed/presentedWhere will testing take placeSpace for social workerWho will oversee testingTemplates Patient/caregiver advisory councilOutcomesOther