Leveraging Electronic Health Records for Reducing Dementia Screening Disparities in Diverse Communities

利用电子健康记录减少不同社区的痴呆症筛查差异

基本信息

批准号：
10525774
负责人：
Abraham Aizer Brody
金额：
$ 84.3万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-21 至 2028-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10525774
关键词：
Address Adoption Affect Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulatory Care Anti-Cholinergics Artificial Intelligence Asian Americans Black race Cardiovascular Diseases Cardiovascular system Caregiver support Caregivers Caring Clinical Cognitive Communities Complex Coupled Dementia Detection Diabetes Mellitus Diagnosis Disadvantaged minority Disease Disparity Early Diagnosis Elderly Electronic Health Record Enrollment Ethnic Population Evaluation Failure Family Future Goals Grant Health Health Status High Prevalence Hypertension Impaired cognition Individual Inequity Intervention Latino Lipids Machine Learning Measures Medicaid Memory Methods Modeling Modernization Monitor Native Americans Neurologist Obesity Outcome Pathogenesis Patient-Focused Outcomes Patients Persons Population Population Heterogeneity Populations at Risk Pragmatic clinical trial Predictive Value Preventive measure Primary Care Qualifying Race Risk Factors Secondary Prevention Smoking Specialist Strategic Planning Technology Testing Therapeutic Agents Underrepresented Minority Uninsured United States age related burden of illness cardiovascular disorder prevention cardiovascular risk factor care delivery clinical decision support cohort dementia risk design economic disparity effectiveness evaluation ethnic minority population evidence base health management human old age (65+)implementation measures improved machine learning method mild cognitive impairment novel novel therapeutics patient engagement pragmatic trial preventive intervention primary care provider primary care setting primary outcome racial diversity racial minority population screening screening disparities screening program secondary outcome socioeconomic disadvantage socioeconomics support tools tool treatment arm uptake usability

项目摘要

Project Summary/Abstract: Alzheimer’s Disease and Alzheimer's Disease related dementias (AD/ADRD) are irreversible conditions affecting over 6 million people in the United States. While the pathogenesis of AD/ADRD is complex, modifiable cardiovascular risk factors contribute to its pathogenesis. These risk factors are unequally distributed, with higher prevalence among socioeconomically disadvantaged and racial and ethnic minority groups, and the problem is compounded by lower rates of cognitive screening and diagnosis across these groups – as documented in Black, Latino, Asian, and Native American populations. While referral to qualified memory specialists (geriatricians and/or neurologists) for evaluation and management is considered gold standard, in practice most diagnosis and management of AD/ADRD occurs in non-specialty (primary care) settings, due to shortage of specialists. Novel cognitive screening programs that leverage electronic health records (EHRs) have the potential to close this gap considerably. In this context, we propose a multicomponent stakeholder- and technology-based framework to improve early detection of MCI and AD/ADRD, to elevate the quality of cognitive screening and secondary prevention within primary care, with a focus on practices that treat patients from socioeconomically and racially diverse backgrounds. We will design and implement an embedded Pragmatic Clinical Trial (ePCT) that involves engaging patients, families and PCPs to refine existing practices on how PCPs should present information on cognitive screening, MCI and AD/ADRD diagnosis, and their linkage with cardiovascular disease. We will leverage an EHR-based clinical decision support tool based on retrospectively validated artificial intelligence (AI) and machine learning (ML) methods for identifying MCI and AD/ADRD. Primary outcome for the ePCT will be the rate of cognitive screening, and secondary outcomes will include diagnosis of dementia, and secondary cardiovascular preventive measures. This ePCT effort will focus on the two NYU Langone Health Brooklyn ambulatory care centers, which include over 70 PCPs and over 10,000 patients age ≥65 years. (With 62% self- identified as non-white). Our Specific Aims are to (Aim 1) Conduct a pilot ePCT to optimize and evaluate the acceptability, usability and adoption of implementing an existing AI/ML tool and PCP decision support in a predominantly racial and ethnic underrepresented minority cohort. (Aim 2) Validate and monitor the ePCT primary outcome of cognitive screening, and secondary outcomes of diagnosis of MCI, AD/ADRD, and cardiovascular disease prevention outcomes. (Aim 3) Perform a sub-analysis of patient outcomes across different racial/ethnic subgroups for differences in uptake of screening, diagnosis, secondary cardiovascular preventative interventions. This pilot ePCT will pave the way for larger scale pragmatic trials that will address an unmet and urgent need in cognitive health management of elderly population, particularly those most vulnerable to the disease.

项目摘要/摘要：阿尔茨海默病和阿尔茨海默病相关痴呆 (AD/ADRD) 是影响患者健康的不可逆病症在美国有超过 600 万人患有 AD/ADRD，而 AD/ADRD 的发病机制是复杂的、可改变的。心血管危险因素促成其发病，这些危险因素分布不均，且较高。在社会经济弱势群体以及种族和族裔群体中普遍存在，问题是此外，这些群体的认知筛查和诊断率较低——正如 Black 中所记录的那样，拉丁裔、亚洲人和美洲原住民人群。同时转介给合格的记忆专家（老年科医生）。和/或神经科医生）进行评估和管理被认为是黄金标准，在实践中大多数诊断和治疗由于缺乏专家，AD/ADRD 的治疗发生在非专业（初级保健）环境中。利用电子健康记录 (EHR) 的认知筛查计划有可能缩小这一差距在这种背景下，我们提出了一个基于多组件利益相关者和技术的框架。改善 MCI 和 AD/ADRD 的早期检测，提高认知筛查和二次筛查的质量初级保健中的预防，重点是从社会经济和种族角度治疗患者的做法我们将设计和实施一个嵌入式实用临床试验（ePCT），其中涉及让患者、家属和 PCP 参与完善有关 PCP 应如何提供信息的现有做法认知筛查、MCI 和 AD/ADRD 诊断及其与心血管疾病的联系。利用基于 EHR 的临床决策支持工具，该工具基于经过回顾性验证的人工智能 (AI) ePCT 的主要成果将是用于识别 MCI 和 AD/ADRD 的机器学习 (ML) 方法。认知筛查率和次要结果将包括痴呆症的诊断和次要结果这项 ePCT 工作将重点关注纽约大学布鲁克林分校 Langone Health 的两家机构。流动护理中心，包括 70 多名 PCP 和 10,000 多名年龄 ≥ 65 岁的患者。我们的具体目标是（目标 1）进行试点 ePCT 以优化和评估实施现有 AI/ML 工具和 PCP 决策支持的可接受性、可用性和采用率主要是种族和族裔代表性不足的少数群体（目标 2）验证和监测 ePCT。主要结果是认知筛查，次要结果是诊断 MCI、AD/ADRD 和心血管疾病预防结果（目标 3）对患者结果进行子分析。不同种族/族裔亚组对筛查、诊断、继发性心血管疾病的接受程度存在差异该试点 ePCT 将为更大规模的实用试验铺平道路，以解决以下问题：老年人，特别是最弱势群体认知健康管理的未满足和迫切需求对疾病。