Enhancing Dementia Diagnosis and Care in Rural Primary Care: A Feasibility Study

DESCRIPTION (Provided by the Applicant): As the population ages, an increased number of persons suffer from dementia. This is a particularly critical concern in rural Oregon: rural areas have higher proportions of older adults than urban and suburban areas and resources to support patients with dementia and their families are often scarce. Research has shown that many persons with dementia are not clinically evaluated or diagnosed. Dementia that is undetected is likely to be poorly managed resulting in an excess negative effect on the individual's general health, safety and wellbeing. The goal of this project is to improve care for older persons with dementia. The specific aims of this feasibility study are to: 1) Test a clinical practice model to improve dementia care (modified ACOVE) in rural primary care practices, and 2) Gather pilot data needed for a planned intervention study. This proposal will provide a preliminary test of the dementia component of the Assessing Care of the Vulnerable Elders (ACOVE-2) model developed at UCLA and RAND Health. The intervention uses a standardized multi-component practice-change effort, that includes: efficient collection of condition-specific clinical data, medical record prompts, patient/family education and activation, and physician decision support and education. The study will be carried out in six rural primary care practices of the Oregon Rural Practice-Based Research Network (ORPRN). Participating clinicians will receive CME training on clinical evaluation, diagnosis, and followup care and resources. During the 3-month study period, the ACOVE protocol and forms will be used with patients aged 75 or older scheduled for routine physicals or general followup care. Patients who screen positive for possible dementia by a practice assistant will be referred to the clinician for dementia evaluation. Patients diagnosed with dementia will be provided with information about dementia and community resources. Pilot data will be collected and analyzed on the effects of the ACOVE model on improving detection of dementia and increasing community referrals and support, clinician confidence in diagnosing and managing dementia, and family satisfaction with care. Clinician satisfaction with and recommendations for modification of the ACOVE will be determined. The results of this study will be used by ORPRN to develop a larger, RO1 level rural physician and family support intervention study.