- Email: [email protected]
TRANSDISCIPLINARY COGNITIVE SPECIALTY CARE IMPROVES PATIENT-CENTERED AND HEALTH SYSTEM OUTCOMES
P492
Poster Presentations: Sunday, July 16, 2017
Figure 1. The Houston Alliance to Address Dementia: a Multi-armed, Systems-based Approach to Making Houston/Harris County, Texas more Dementia Capable. *IDD denotes Intellectual and Developmental Disability Population.
may not offer family education and support. Methods: We used electronic medical records from 2013 to compare outcomes in 8887 patients age >65 in primary care community clinics and in 290 patients in our transdisciplinary cognitive specialty clinic. We examined patient-centered outcomes a care partner panel identified as important, and health system outcomes a health care leadership panel judged sufficient to change practice. The difference in dichotomous outcomes was tested with Chi-square tests and count outcomes were compared with the exact rate ratio test assuming Poisson distribution. Results: Patients with cognitive impairment were much more likely to achieve patient-centered outcomes when seen by the cognitive specialty team than only primary care. Family support from a social worker was documented in 77% vs 4.2%, use of drugs classified as inappropriate on the Beer’s list was 9% vs. 36%, and referral for driving evaluation was 30% vs. 0.8% (all p <0.001). Only documented advanced directives were not significantly different, 27% vs. 24% (p ¼ 0.43). Emergency visit rate was lower (0.13 vs. 0.20, p ¼ 0.03), and there was a trend toward better diabetes control (p¼0.06) with specialty care. Patients with both diabetes and cognitive impairment achieved even lower rates of patient-oriented outcomes in primary care: family support was 0.35% vs. 72% and completion of advanced directives was 12% vs. 23%, (both p <0.001). Conclusions: Cognitive specialty teams are more likely to achieve patient-centered and health system outcomes than primary care. Current strategies in primary care fail to identify as many patients with cognitive impairment as expected, so considerable opportunity for improvement remains. Cognitive impairment may contribute to poor control of diabetes and diabetes may interfere with outcomes in primary care setting because attention is distracted away from cognitive care. A pragmatic, prospective, randomized trial would address limitations of this retrospective, observational study.
P1-520
Figure 2. The Houston Alliance to Address Dementia: a Multi-armed, Systems-based Approach to Making Houston/Harris County, Texas more Dementia Capable.
P1-519
TRANSDISCIPLINARY COGNITIVE SPECIALTY CARE IMPROVES PATIENTCENTERED AND HEALTH SYSTEM OUTCOMES
Norman L. Foster1, Nancy A. Allen1, Kelly D. Garrett2, Angela Y. Wang1, Melissa S. Briley1, Kevin M. Duff1, Jian Ying1, Yao He1, Reid Holbrook1, 1 University of Utah, Salt Lake City, UT, USA; 2Intermountain Healthcare, Salt Lake City, UT, USA. Contact e-mail: [email protected] Background: Early referral to cognitive specialty clinics is recom-
mended in most European practice guidelines. In the US, where most cognitive problems are managed in primary care, the role of cognitive specialty clinics is controversial and referrals are inconsistent and often delayed. Specialists without a dementia focus
PRIMARY CARE INITIATIVES FOR COMPLEX NEUROCOGNITIVE DISORDER CARE: PROTOCOL FOR AN INNOVATIVE MIXED-METHODS DESIGN
Susan E. Bronskill1, Isabelle Vedel2, Carrie A. McAiney3, Yves Couturier4, Genevieve Arsenault-Lapierre2, Claire Godard-Sebillotte2, Nadia Sourial2, Rachel Simmons2, Paula A. Rochon5, Erin Strumpf2, Sarah Pakzad6, Howard Bergman2, 1Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; 2McGill University, Montreal, QC, Canada; 3 McMaster University, Hamilton, ON, Canada; 4University of Sherbrooke, Sherbrooke, QC, Canada; 5Women’s College Hospital, Toronto, ON, Canada; 6University of Moncton, Moncton, NB, Canada. Contact e-mail: [email protected] Background: Multiple Canadian reforms are being implemented in primary care for neurocognitive disorders (NCD). While Quebec has developed a top-down, province-wide plan, both Ontario and New Brunswick rely on bottom-up initiatives originating within individual primary care clinics. Our pan-Canadian research group is studying the implementation of these different strategies to address NCD, and trying to elucidate key factors leading to success. As all streams of the project will be conducted in various clinical sites across three provinces, integrative data from these different approaches requires an innovative methodology. Methods: In order to ensure effective dissemination of study results and maximize research impact, protocol development involved stakeholder participation and engagement along with researchers in qualitative, quantitative, and mixed-methods study design. Stakeholders include
Poster Presentations: Sunday, July 16, 2017
Figure 1. The Houston Alliance to Address Dementia: a Multi-armed, Systems-based Approach to Making Houston/Harris County, Texas more Dementia Capable. *IDD denotes Intellectual and Developmental Disability Population.
may not offer family education and support. Methods: We used electronic medical records from 2013 to compare outcomes in 8887 patients age >65 in primary care community clinics and in 290 patients in our transdisciplinary cognitive specialty clinic. We examined patient-centered outcomes a care partner panel identified as important, and health system outcomes a health care leadership panel judged sufficient to change practice. The difference in dichotomous outcomes was tested with Chi-square tests and count outcomes were compared with the exact rate ratio test assuming Poisson distribution. Results: Patients with cognitive impairment were much more likely to achieve patient-centered outcomes when seen by the cognitive specialty team than only primary care. Family support from a social worker was documented in 77% vs 4.2%, use of drugs classified as inappropriate on the Beer’s list was 9% vs. 36%, and referral for driving evaluation was 30% vs. 0.8% (all p <0.001). Only documented advanced directives were not significantly different, 27% vs. 24% (p ¼ 0.43). Emergency visit rate was lower (0.13 vs. 0.20, p ¼ 0.03), and there was a trend toward better diabetes control (p¼0.06) with specialty care. Patients with both diabetes and cognitive impairment achieved even lower rates of patient-oriented outcomes in primary care: family support was 0.35% vs. 72% and completion of advanced directives was 12% vs. 23%, (both p <0.001). Conclusions: Cognitive specialty teams are more likely to achieve patient-centered and health system outcomes than primary care. Current strategies in primary care fail to identify as many patients with cognitive impairment as expected, so considerable opportunity for improvement remains. Cognitive impairment may contribute to poor control of diabetes and diabetes may interfere with outcomes in primary care setting because attention is distracted away from cognitive care. A pragmatic, prospective, randomized trial would address limitations of this retrospective, observational study.
P1-520
Figure 2. The Houston Alliance to Address Dementia: a Multi-armed, Systems-based Approach to Making Houston/Harris County, Texas more Dementia Capable.
P1-519
TRANSDISCIPLINARY COGNITIVE SPECIALTY CARE IMPROVES PATIENTCENTERED AND HEALTH SYSTEM OUTCOMES
Norman L. Foster1, Nancy A. Allen1, Kelly D. Garrett2, Angela Y. Wang1, Melissa S. Briley1, Kevin M. Duff1, Jian Ying1, Yao He1, Reid Holbrook1, 1 University of Utah, Salt Lake City, UT, USA; 2Intermountain Healthcare, Salt Lake City, UT, USA. Contact e-mail: [email protected] Background: Early referral to cognitive specialty clinics is recom-
mended in most European practice guidelines. In the US, where most cognitive problems are managed in primary care, the role of cognitive specialty clinics is controversial and referrals are inconsistent and often delayed. Specialists without a dementia focus
PRIMARY CARE INITIATIVES FOR COMPLEX NEUROCOGNITIVE DISORDER CARE: PROTOCOL FOR AN INNOVATIVE MIXED-METHODS DESIGN
Susan E. Bronskill1, Isabelle Vedel2, Carrie A. McAiney3, Yves Couturier4, Genevieve Arsenault-Lapierre2, Claire Godard-Sebillotte2, Nadia Sourial2, Rachel Simmons2, Paula A. Rochon5, Erin Strumpf2, Sarah Pakzad6, Howard Bergman2, 1Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada; 2McGill University, Montreal, QC, Canada; 3 McMaster University, Hamilton, ON, Canada; 4University of Sherbrooke, Sherbrooke, QC, Canada; 5Women’s College Hospital, Toronto, ON, Canada; 6University of Moncton, Moncton, NB, Canada. Contact e-mail: [email protected] Background: Multiple Canadian reforms are being implemented in primary care for neurocognitive disorders (NCD). While Quebec has developed a top-down, province-wide plan, both Ontario and New Brunswick rely on bottom-up initiatives originating within individual primary care clinics. Our pan-Canadian research group is studying the implementation of these different strategies to address NCD, and trying to elucidate key factors leading to success. As all streams of the project will be conducted in various clinical sites across three provinces, integrative data from these different approaches requires an innovative methodology. Methods: In order to ensure effective dissemination of study results and maximize research impact, protocol development involved stakeholder participation and engagement along with researchers in qualitative, quantitative, and mixed-methods study design. Stakeholders include