ToolBox Detect: Low Cost Detection of Cognitive Decline in Primary Care Settings

ToolBox Detect：初级保健环境中认知衰退的低成本检测

基本信息

批准号：
10417224
负责人：
RICHARD GERSHON
金额：
$ 137.87万
依托单位：
NORTHWESTERN UNIVERSITY AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-30 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10417224
关键词：
Adult Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulatory Care Behavioral Caregivers Caring Chronic Clinical Cognitive aging Cognitive deficits Communities Dementia Detection Diagnosis Early Diagnosis Early Intervention Elderly Electronic Health Record Evaluation Family Family Process Federally Qualified Health Center Future Goals Health Health Personnel Healthcare Impaired cognition Impairment Individual Interviewer Lead Link Measurement Measures Medical Medicare National Institute of Neurological Disorders and Stroke Neurologic Outcome Outpatients Paper Patient Care Patients Personal Satisfaction Primary Health Care Protocols documentation Resources Self Administration Services Structure System Technology Testing Time United States National Institutes of Health Visit Wolves Work acceptability and feasibility base care providers case finding cognitive function cognitive testing community setting cost disadvantaged population effectiveness evaluation innovation medically underserved mild cognitive impairment patient population practice setting primary care setting randomized trial socioeconomic disadvantage standard of care treatment as usual

项目摘要

PROJECT SUMMARY Our objective is to widely implement and evaluate a user-centered, scalable, electronic health record (EHR) - linked strategy for the routine detection of cognitive decline among diverse primary care settings. Cognitive impairment is most prevalent among adults 65 and older, yet less than half of cases are detected and/or diagnosed in primary care settings. It is now increasingly accepted that early detection is critically important to optimize care planning, sustained independence, management of chronic conditions and appropriate caregiver involvement. In 2011, Medicare initiated a covered, Annual Wellness Visit (AWV) that includes a cognitive assessment to detect impairment, Alzheimer’s disease and related dementias (ADRD). While this has presented new opportunity for case finding, implementation of AWVs has been variable, including how cognitive function is assessed. Clinicians may rely on more basic, paper-based, interviewer-administered tests that may be less precise and more cumbersome to clinical workflow – affecting the fidelity of an early detection strategy. Further, many practices lack a clear protocol for referral when impairment is determined, and a process for family involvement and establishing care goals. Practical, sustainable, scalable strategies are urgently needed to help primary care providers who are on the frontlines of healthcare routinely assess cognitive function as part of AWVs (or whenever a cognitive impairment is suspected), identify concerns and have a protocol for referrals and care management. This is especially true for resource-constrained clinical settings, such as Federally Qualified Health Centers (FQHCs) caring for more vulnerable patient populations. Northwestern developed and continues to innovate the NIH Toolbox for the Assessment of Neurological and Behavioral Function®. Since 2017, our team has worked closely with primary care practices to develop a brief, technology-enabled, self-administered, EHR-linked cognitive assessment derived from the NIH Toolbox. We also devised a detailed protocol for its use and how results of our test, known as ToolboxDetect, can inform patient care. We propose a large-scale, primary care practice-randomized trial to implement and comprehensively evaluate ToolboxDetect as a standard of care with AWVs, linked to an EHR (Epic). Diverse, academic and community settings are included to optimize future dissemination efforts. Our primary aim is to evaluate the effectiveness of ToolboxDetect, compared to enhanced usual care, to promote timely detection of cognitive decline and its care management. Our secondary aims are to: 2) Disseminate and implement ToolboxDetect among a large Federally Qualified Health Center Network and assess its feasibility and acceptability for use; 3) Investigate the fidelity of ToolboxDetect, and identify any patient, caregiver, healthcare provider and/or system barriers to its optimal, sustained implementation; and 4) Determine costs associated with implementing ToolboxDetect from a primary care perspective.

项目概要我们的目标是广泛实施和评估以用户为中心的、可扩展的电子健康记录 (EHR) - 用于在不同初级保健环境中常规检测认知能力下降的相关策略。认知障碍在 65 岁及以上的成年人中最为普遍，但只有不到一半的病例被发现和/或现在越来越多的人认为，早期发现对于初级保健机构至关重要。优化护理计划、持续独立、慢性病管理和适当的护理人员 2011 年，Medicare 启动了一项承保的年度健康就诊 (AWV)，其中包括认知检查。评估以检测损伤、阿尔茨海默氏病和相关痴呆症（ADRD）。病例发现的新机会，AWV 的实施是可变的，包括认知功能如何变化临床医生可能会依赖更基本的、基于纸质的、由访谈者进行的测试，但这些测试可能较少。精确且对临床工作流程来说更加繁琐——影响早期检测策略的保真度。许多做法缺乏明确的转诊协议，以确定是否有损伤，也缺乏家庭程序迫切需要参与并制定实用、可持续、可扩展的战略来提供帮助。作为 AWV 的一部分，处于医疗保健第一线的初级保健提供者会定期评估认知功能（或每当怀疑有认知障碍时），确定问题并制定转诊和护理方案对于资源有限的临床环境（例如联邦合格医疗机构）尤其如此。照顾弱势患者群体的中心 (FQHC)。西北大学开发并持续创新 NIH 神经系统评估工具箱自 2017 年以来，我们的团队与初级保健实践密切合作，制定了一份简短的、我们还从 NIH 工具箱中衍生出技术支持、自我管理、与 EHR 相关的认知评估。为其使用以及我们的测试结果（称为 ToolboxDetect）如何告知患者制定了详细的方案我们建议进行大规模的初级保健实践随机试验来实施和全面实施。将 ToolboxDetect 评估为 AWV 的护理标准，与 EHR (Epic) 相关联。包括社区设置，以优化未来的传播工作。我们的主要目的是评估 ToolboxDetect 与增强的常规护理相比的有效性，以促进及时发现认知能力下降及其护理管理我们的次要目标是：2）传播和管理。在大型联邦合格健康中心网络中实施 ToolboxDetect 并评估其可行性使用的可接受性；3) 调查 ToolboxDetect 的保真度，并识别任何患者、护理人员、医疗保健人员供应商和/或系统对其最佳、持续实施的障碍；以及 4) 确定与此相关的成本从初级保健的角度实施 ToolboxDetect。