Quality indicator framework for primary care of patients with dementia

Sourial, Nadia; Godard‐Sebillotte, Claire; Bronskill, Susan E.; Hacker, Georgia; Vedel, Isabelle

doi:10.46747/cfp.6809e270

Cited by 10 publications

(5 citation statements)

References 25 publications

(39 reference statements)

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“…We selected 20 indicators grounded in a validated Quality of Dementia Care Framework (Sourial et al 2022) that spans the continuum of care (ambulatory care, acute care and pharmacological care). The operational definitions of all indicators used are provided in Appendices 4 and 5 (available online at www.longwoods.com/content/27281).…”

Section: Discussionmentioning

confidence: 99%

Rural-Urban Differences in Healthcare Use in Persons With Dementia Between 2000 and 2019: A Quebec Population-Based Study

Arsenault-Lapierre,

Godard-Sebillotte,

Bui

et al. 2024

hcpol

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Background: Rural persons with dementia face medical services gaps. This study compares the health service utilization of rural and urban community-dwelling individuals with incident dementia. Methods: This study used a repeated annual cross-sectional cohort design spanning a period from 2000 to 2019 analyzing age-adjusted rates for 20 indicators of service use and mortality one year after diagnosis in Quebec administrative databases. Results: Of 237,259 persons, 20.1% were rural. Most rural persons had more emergency department visits and hospitalizations, shorter stays, less alternate level of care and fewer family physicians' and cognition specialists' visits. All groups had similar long-term care and mortality rates. Conclusion: Policy implications of these disparities are discussed.

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Section: Discussionmentioning

confidence: 99%

Rural-Urban Differences in Healthcare Use in Persons With Dementia Between 2000 and 2019: A Quebec Population-Based Study

Arsenault-Lapierre,

Godard-Sebillotte,

Bui

et al. 2024

hcpol

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“…There is a growing literature on primary care quality indicators for chronic conditions including dementia. For example, Sourial et al (2022) developed a framework of primary care quality indicators adapted to PwD; however, these indicators do not appear to account for the influence of chronic conditions on dementia care [ 72 ]. Similarly, Bodenheimer et al (2002) described a chronic care model that is not specific to dementia but helps to guide higher-quality chronic illness management within primary care [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

Dementia and comorbidities in primary care: a scoping review

Bergman,

Borson,

Jessen

et al. 2023

BMC Prim. Care

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Background People with dementia (PwD) are known to have more chronic conditions compared to those without dementia, which can impact the clinical presentation of dementia, complicate clinical management and reduce overall quality of life. While primary care providers (PCPs) are integral to dementia care, it is currently unclear how PCPs adapt dementia care practices to account for comorbidities. This scoping review maps recent literature that describes the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities, identifies critical knowledge gaps and proposes potential avenues for future research. Methods We searched for peer-reviewed literature published between 2017–2022 in MEDLINE, Cochrane Library, and Scopus using key terms related to dementia, primary care, and comorbidity. The literature was screened for relevance by title-abstract screening and subsequent full-text screening. The prioritized papers were categorized as either ‘Risk Assessment and Prevention’, ‘Screening, Detection, and Diagnosis’ or ‘Management’ and were further labelled as either ‘Tools and Technologies’, ‘Recommendations for Clinical Practice’ or ‘Programs and Initiatives’. Results We identified 1,058 unique records in our search and respectively excluded 800 and 230 publications during title-abstract and full-text screening. Twenty-eight articles were included in our review, where ~ 50% describe the development and testing of tools and technologies that use pre-existing conditions to assess dementia risk. Only one publication provides official dementia screening guidelines for PCPs in people with pre-existing conditions. About 30% of the articles discuss managing the care of PwD, where most were anchored around models of multidisciplinary care and mitigating potentially inappropriate prescribing. Conclusion To our knowledge, this is the first scoping review that examines the role for PCPs in the prevention, detection/diagnosis and management of dementia in the context of comorbidities. Given our findings, we recommend that future studies: 1) further validate tools for risk assessment, timely detection and diagnosis that incorporate other health conditions; 2) provide additional guidance into how comorbidities could impact dementia care (including prescribing medication) in primary care settings; 3) incorporate comorbidities into primary care quality indicators for dementia; and 4) explore how to best incorporate dementia and comorbidities into models/frameworks of holistic, person-centred care.

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“…On the first page, nine indicators were selected from provincial clinical-administrative data from the Quebec Integrated Chronic Disease Surveillance System developed by the Institut national de santé publique du Québec [ 44 ]. Indicator selection was based on a conceptual framework on the quality of care for dementia, covering a continuum of care from primary care to emergency use and hospitalizations [ 45 ]. Eight of these indicators (type of physician most regularly visited, percentage of people with at least one visit to a family doctor, average number of visits to a family doctor per person, percentage of people with at least one emergency room visit, percentage of people with at least one hospitalization, average number of days hospitalized per person, percentage of people with at least one hospitalization with an alternative care level—representing patients who are hospitalized but no longer requiring acute care and waiting for long-term placement—and average number of days in care level) were measured in 2019-2020 in the population of individuals with dementia 65 years and older, and one indicator (prevalence) was measured between 2000-2001 and 2019-2020 in the population of individuals with dementia 40 years and older.…”

Section: Methodsmentioning

confidence: 99%

Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations

Arsenault-Lapierre,

Lemay-Compagnat,

Guillette

et al. 2024

JMIR Form Res

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Background Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization’s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled “university/peripheral”; organizations for which only part of the territory is in rural areas, labeled “mixed”; and organizations in remote or isolated areas, labeled “remote/isolated”) and according to different types of participants (managers, leading clinicians, and other participants). Results Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards.

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Quality indicator framework for primary care of patients with dementia

Cited by 10 publications

References 25 publications

Rural-Urban Differences in Healthcare Use in Persons With Dementia Between 2000 and 2019: A Quebec Population-Based Study

Rural-Urban Differences in Healthcare Use in Persons With Dementia Between 2000 and 2019: A Quebec Population-Based Study

Dementia and comorbidities in primary care: a scoping review

Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations

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