A Pragmatic Trial of the UCSF Brain Health Assessment for the Detection of Cognitive Impairment in Primary Care

加州大学旧金山分校脑健康评估用于检测初级保健中认知障碍的实用试验

• 批准号: 10524698
• 负责人: Katherine Laurel Possin
• 金额: $ 162.41万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10524698
• 关键词: Address; African American; Age; Aging; Algorithms; Alzheimer' s Disease; Asian Pacific Islander; Behavioral Symptoms; Black race; California; Caring; Clinic; Cluster randomized trial; Cognitive; Communities; Consultations; Dementia; Detection; Diagnosis; Diagnostic; Disclosure; Early Diagnosis; Economics; Elderly; Epidemiology; Family; Frequencies; Funding; Future; Goals; Gold; Healthcare; Hispanic; Impaired cognition; Impairment; Integrated Health Care Systems; Language; Latino; Limited English Proficiency; Medical; Medicare; Memory; Neuropsychology; Nurses; Outcome; Pathway interactions; Patients; Penetration; Persons; Population; Population Heterogeneity; Primary Health Care; Provider; Randomized; Research; Resources; Risk; San Francisco; Specialist; Specificity; Standardization; Surveys; Tablet Computer; Tablets; Testing; Time; Universities; Visuospatial; Work; base; brain health; care outcomes; cognitive testing; cohort; comorbidity; comparison group; cost; design; diagnosis standard; education resources; effectiveness evaluation; ethnic diversity; ethnic minority; experience; follow-up; functional decline; health assessment; health care disparity; health disparity; health disparity populations; health equity; implementation barriers; implementation science; implementation strategy; improved; informant; medical specialties; member; neighborhood disadvantage; neurocognitive disorder; novel; novel strategies; payment; pragmatic trial; precision medicine; primary outcome; racial and ethnic; racial and ethnic disparities; skills; social determinants; social health determinants; statistics; telehealth; treatment as usual; treatment effect; user-friendly

Efficient and user-friendly paradigms to detect cognitive impairment, including dementia are needed in primary care. The UCSF Brain Health Assessment accurately detects cognitive impairment via an appealing tablet interface with automated scoring and EMR integration. With the first round of funding, we validated the paradigm in English and Spanish speakers, developed regression-based norms that accurately classify patients by their likelihood of impairment, identified racial and ethnic disparities and barriers to brain health care, and at UCSF primary care the paradigm increased diagnosis rates by 40%. The primary goals of the proposed work are to evaluate the effectiveness of the paradigm for improving brain health care via a large pragmatic trial, to address challenges to implementation, and to pioneer precision medicine approaches to reference group adjustments. In Aim 1, we will conduct a pragmatic cluster randomized trial in 26 Kaiser Southern California primary care clinics to determine the effectiveness of the paradigm on detection rates and other brain health outcomes. In Aim 2, we will identify and address challenges to implementation and sustainability. In Aim 3, we will further diversify our well-characterized reference group and refine our detection algorithms to adjust for social determinants of brain health (not race), which is novel and also critical for a paradigm to be appropriate for all members of the increasingly diverse U.S. older adult population. If successful, this work will produce a validated paradigm that is available to address the unmet need to detect cognitive impairment, including dementia, in large and diverse populations seen in primary care, and provide useful information about wide scale implementation of the paradigm to mitigate healthcare disparities and improve brain health care.

初级保健需要有效且用户友好的范例来检测认知障碍（包括痴呆症）。 UCSF 大脑健康评估通过具有自动评分和 EMR 集成功能的有吸引力的平板电脑界面准确检测认知障碍。通过第一轮资金，我们在英语和西班牙语使用者中验证了这一范例，制定了基于回归的规范，根据患者受损的可能性对患者进行准确分类，确定了种族和民族差异以及大脑保健的障碍，并在加州大学旧金山分校初级保健中心范式将诊断率提高了 40%。拟议工作的主要目标是通过大型实用试验评估改善大脑保健的范例的有效性，解决实施方面的挑战，并开创参考组调整的精准医学方法。在目标 1 中，我们将在南加州 26 个 Kaiser 初级保健诊所进行一项务实的整群随机试验，以确定该范式对检测率和其他大脑健康结果的有效性。在目标 2 中，我们将确定并解决实施和可持续性方面的挑战。在目标 3 中，我们将进一步使我们特征明确的参考组多样化，并完善我们的检测算法，以适应大脑健康的社会决定因素（而不是种族），这是新颖的，对于适合日益增长的所有成员的范式也至关重要。多样化的美国老年人口。如果成功，这项工作将产生一个经过验证的范式，可用于解决在初级保健中发现的大量不同人群中检测认知障碍（包括痴呆症）的未满足需求，并提供有关大规模实施该范式以减轻医疗保健的有用信息差异并改善大脑保健。