Henry Ford Health SystemDementia Screening for Senior Patients

Picker awards established in 2003

Independent nonprofit Patient-centered care Improvement of patient’s

experience and interaction with health care providers

Picker Surveys are the world standard for measuring performance “through the patient’s eyes”

“Understanding and respecting patients’ values, preferences, and expressed needs is the foundation of patient-centered care” Harvey Picker

Founder 1915-

2008

World Health Organization Significant threat to health of all nations First chronic disease to be cited

Dementia as Chronic Disease Genetic vulnerability & environmental exposure Importance of risk factor modification

▪ Disease modification National Alzheimer’s Association

Pre-dementia states▪ Mild Cognitive impairment▪ Pre-clinical AD

Earliest stages are target of treatment National Alzheimer’s Project Grant Medicare Wellness Visit

Patients must be asked about cognition at an annual visit

If the costs of AD were a world economy, it would rank as the 13th largest

AD

Dispel the mythology of memory loss with aging “Normal” age related cognitive decline is not normal

Make the Diagnosis Alzheimer’s Disease? Lewy Body Disease? Frontal Dementia?

Care vs Cure Disease modification strategies Family as patient Community Alliances

Current norms outdated MCI Preclinical changes

Neuropsych tests change late in course NP testing normal in

brains with AD changes Normal NP test does not

mean brain is normal Second to last

biomarker to change

New treatments target preclinical states Biomarkers and risk

factor identification Serial testing (within

subjects) more powerful to predict pathology ▪ Need office easy to

administer office based tool▪ Repeat regularly as part of

health maintenance

Lack of time for assessment

Uncertainty regarding diagnostics

Complexity of cognitive testing

Lack of resources for management of behavioral and social issues, community resources, caregiver training

Henry Ford Hospital

Routine dementia screening annually, starting at age 70

Internet tools for cognitive and behavioral assessments

Identify a specific dementia syndrome

Provide appropriate medical and non-medical treatments

Align patient and caregiver with network of community supports

NIH Toolbox

Public domain web-based assessments Computerized 30 minutes Scoring and interpretationOversight by support personnelIdentifies MCI, AD, non-AD

NeuroQual

Behavior assessmentCaregiver distress

Accessed through CarePlusGuides diagnostic history, physical exam, tests, and treatment Identifies red flags for referralDirect link on CarePlus for Neurology referral if needed

EducationBehavior

managementCommunity referrals

All are referredDirect link on careplus

Located at HFH

Grosfeld Collaborative

June 1-Sept 30Development

Refine web based toolsInterpretive componentDesignate space in each clinic for testingPurchase computersIT issuesPatient advisory groupIdentify 2 primary care clinics for pilotDevelop physician training CDsHire social workerDesignate space for social workerOutcomes measures designated

Oct 1-Nov 30Training

Physician Support personnelSocial workersMeet with advisory group

Dec 1-Feb 28Pilot

Every patient >/= 70 screened in 2 clinicsDatabase collectionMeet with advisory group

Mar 1-May 31Evaluation

Computerized screen for patients >/=70Screening labsMRI (or CT) brainSpecific diagnosisCholinesterase inhibitor for AD or DLBDocumentation of social work outreach call/conferenceMeet with advisory group

Physician History Medications

▪ Anticholinergic burden reduction

▪ Sedative reduction

Targeted neuro exam Objective Tests Treatment

▪ Medical▪ Nonmedical

Reduce Vascular Risk Driving

Social Work Stage dependent learning

series Care management Day respite Area Agency on Aging

referral Support group Behavior management Sleep guidelines Meals on wheels Referral for Financial

PlanningMedical AssistantComputerized cognitive testComputerized behavioral assessmentCaregiver distress/burden

Patient satisfactionDiagnosesUse of dementia medicationsPhysician satisfaction

Any health care organization or practitioner with EMR can utilize this new process Organization must

refine/adapt NIH toolbox with interpretative component

There is a guideline/template for primary care physicians

There is a social work template

Alzheimer’s association chapters exist in all 50 states All chapters can adopt the

reimbursement model for their social workers

Training modules on CDs to be shared with other institutions

Matching funds Siemens Microsoft Pfizer/Eisai

No cost to maintain templates in Careplus once created/modified

No proprietary costs to utilize NIH toolbox

Alzheimer’s social workers can bill for services

Physicians are more likely to adopt age specific screening when testing is Standardized Interpreted Performed by a

technician Reimbursement

commensurate with complexity of visit

How the topic is framed/presentedWhere will testing take placeSpace for social workerWho will oversee testingTemplates Patient/caregiver advisory councilOutcomesOther