Tools for Better Dementia Care
Quality measures and clinical tools can bring focus and clarity to caring for patients with cognitive impairment and supporting their caregivers.
Fam Pract Manag. 2019 Jan-Feb;26(1):11-16.
Author disclosures: no relevant financial affiliations disclosed.
Alzheimer's Disease is the sixth-leading cause of death in the United States, and one in three American seniors dies of some form of dementia.1 Caring for adults with dementia challenges physicians' usual paradigm of establishing a definitive diagnosis and then offering treatments to either alleviate the symptoms or improve the prognosis. Frustrated physicians may feel “there's nothing that can be done” and stick with what they know: focusing on the patients' co-morbid conditions, such as high cholesterol, hypertension, and diabetes. For the patients and their caregivers, however, it is dementia's cognitive, functional, and behavioral losses that most affect their quality of life. Diagnosis and treatment options for dementia may one day improve. In the meantime, focusing on what can be done, using a navigational framework and clinical tools like the ones described in this article, can help us to more effectively help patients and their families.
USING DEMENTIA QUALITY MEASURES AND CARE KITS
The American Academy of Neurology and the American Psychiatric Association convened a work group of 26 members (including Dr. Unwin) from 21 international organizations “to conceptualize the best possible care for patients with dementia and their caregivers and to operationalize optimal processes for delivering such care.”2 The resulting Dementia Management Quality Measurement Set, disseminated in 2016, provides clinicians with a nationally recognized, evidence-based, clearly defined, effective group of metrics with which to evaluate their current level of care and that serves as a basis for quality improvement initiatives. (See “Dementia Management Quality Measurement Set.”) Groups can use established quality improvement processes, such as Plan, Do, Study, Act (PDSA), to systematically target specific areas. For example, clinicians could collect baseline data on how often they diagnose dementia and then develop and initiate a plan to enhance dementia assessment and diagnosis. They could then collect data on their plan's effectiveness and modify it as necessary.
The Dementia Management Quality Measurement Set gives physicians goals to pursue in improving their care of patients and communication with caregivers.
Physicians can use dementia toolkits to build tailored care plans that focus on the patient's short-term and long-term needs and goals.
Some elements of dementia care can be performed by nonclinicians, improving clinical workflow.
Medicare now reimburses physicians for cognitive assessment and care plan services.
DEMENTIA MANAGEMENT QUALITY MEASUREMENT SET
|Measure title||Measure description|
Disclosure of dementia diagnosis
Percentage of patients with a qualifying dementing disorder or disease whose diagnosis has been disclosed
Referencesshow all references
1. Alzheimer's Association. 2018. Alzheimer's Disease Fact and Figures. https://www.alz.org/alzheimers-dementia/facts-figures. Accessed Nov. 7, 2018....
2. Sanders AE, Nininger J, Absher J, Bennett A, Shugarman S, Roca R. Quality improvement in neurology: dementia management quality measurement set update. Neurology. 2017;88(20):1951–1957.
3. American Academy of Family Physicians. Cognitive Care Kit. https://www.aafp.org/patient-care/public-health/cognitive-care.html. Accessed Nov. 7, 2018.
4. Alzheimer's Association. Cognitive Impairment Care Planning Toolkit. https://www.alz.org/getmedia/8db1c751-36b2-496b-ada7-6f015a080f02/cognitive-impairment-care-planning-toolkit. Accessed Nov. 7, 2018.
5. Centers for Medicare & Medicaid Services website. Physician Fee Schedule Search. https://www.cms.gov/apps/physician-fee-schedule/. Accessed Nov. 12, 2018.
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