Title

Implementation of Standardized Screening for Cognitive Dysfunction at a Multispecialty Group Practice

Document Type

Presentation

Publication Date

4-20-2017

Comments

Advisor:

MR Cooper, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA

Abstract

Many elderly adults in the United States suffer from cognitive issues that can range from mild cognitive impairment to severe dementia. There often is a diagnostic delay before providers recognize these conditions, which can lead to affected patients and their families suffering adverse medical and social consequences. National advisory groups have offered conflicting viewpoints as to the benefits of employing a structured assessment to improve timely detection of cognitive impairment. The Mini-Cog™ screening test for cognitive impairment has been shown in studies to be easy to incorporate in the work flow of support staff in physician offices, and to be accurate for detection of problems with cognition in the elderly. Numerous studies have reported the ability of structured screening assessments to detect impairment at academic centers; the literature is not as robust on the topic of employing such assessments in large community-based practices. The results of a study of patients age 75 and above who presented for Annual Wellness Visits (AWVs) at Premier Medical Associates (PMA) are reported. At three of PMAs primary care offices 58.3% of 789 patients were screened by medical assistants with a Mini-Cog™ during their AWV. At the four primary care offices that followed usual care, 516 patients had an AWV over four months, and three had a diagnosis consistent with cognitive dysfunction added to their active problem list. At the three offices that employed standardized Mini-Cog™ screening, 11 out of 460 patients had a diagnosis consistent with cognitive dysfunction entered on their active problem lists (p= 0.018). The strengths and barriers identified as a result of this program are explored. Strategies to increase compliance with screening during AWVs and to begin the program at the four intervention sites are described.

Presentation: 34:24