and training. We will present a care strategy and pathway to address these three areas. Conclusion: Patients with dementia who are admitted to acute care hospitals may have better outcomes with attention to three elements of care. These three elements should form the basis for improvement efforts for these patients.Background:Intermountain Healthcare is the largest healthcare system in the Intermountain West, delivering care in 185 clinics and 22 hospitals across Utah and the surrounding regions. Queries of our electronic medical record indicated that prevalence of dementia was below expectations based on population-based estimates. Thus, we suspected underreporting of cognitive impairment and wide variation in clinical care. The Neurosciences Cognitive Care Development Team created a system-wide approach to diagnosing and treating mild cognitive impairment and dementia. Our aim was to determine whether a primary-care focused protocol would improve both the detection of cognitive impairment as well as the quality of care provided. Methods: The cognitive care team invited stakeholder participation from neurology, psychology, mental health, geriatrics, primary care, nursing, home care, hospice, care management, radiology, administration, patients, caregivers, and local community and governmental organizations. Our team was supported with a data manager, outcomes analyst, and technical writer. Data for analysis was retrieved from the Intermountain Enterprise Data Warehouse. We developed a standardized protocol to evaluate cognitive impairment, including how primary care providers screen for dementia at the Medicare annual wellness visit (AWV). A positive Mini-Cog at the AWV or physician, patient, or family concern about cognitive impairment prompt a diagnostic workup that includes focused history from the patient and a knowledgeable informant, objective cognitive exam (Montreal Cognitive Assessment), functional assessment, medication reconciliation, and screening for delirium. Guidance regarding diagnosis, neuroimaging, indications for specialty referral, and non-pharmacologic treatment for mild cognitive impairment and dementia, as well as pharmacologic treatment by specific diagnosis was provided as part of the protocol. We created tools to record results of screenings, assessments, and interventions in the electronic medical record such that pre-and post-implementation comparisons could be made. We disseminated the new protocol via trainings at the leadership, regional, and clinic levels. Adherence to the cognitive care protocol, increase in detection rate of dementia, and primary care provider satisfaction will be analyzed. Conclusions: By standardizing our primary care approach to cognitive disorders, we leveraged limited resources to improve cognitive care delivery to one third of patients aged 65 and older in Utah.
Parmi les maladies chroniques, le soutien et les soins intégrés des usagers atteints de déficits cognitifs légers et de démences, dont la maladie d’Alzheimer, est une priorité de santé publique en France et aux États-Unis d’Amérique. Si des progrès sont possibles en France, l’expérience d’Intermountain Healthcare aux États-Unis d’Amérique peut être source d’expérimentations probantes. Son programme de soutien et de soins intégrés pour les usagers atteints de déficits cognitifs légers (Mild Cognitiv Impairment-MCI), de démences et de la maladie d’Alzheimer est développé au sein d’un système de santé organisé en quatre niveaux complémentaires et intégré à une assurance santé, favorisant la confiance et l’engagement. Il met en œuvre les modèles des soins chroniques (Chronic Care Model) et des soins en équipe (Team-Based Care). Cela crée un soutien et des soins multidisciplinaires et globaux, protocolisés et stratifiés, planifiés et suivis. La prévention et les soins ambulatoires intégrant les soins spécialisés de second recours aux soins de premier recours sont développés. Soutenus par un système informatique indépendant et sécurisé ainsi que par des formations initiales et continues partagées, ce programme atteint des objectifs d’amélioration de la santé de la population, d’accroissement de la qualité des soins et de réduction des coûts (Triple Aim). Ce programme améliore l’efficience clinique et l’efficience organisationnelle. Il accroît également l’égalité d’accès à de meilleurs soins et à la santé pour toute la population, particulièrement pour les personnes âgées.
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