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Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program
Author(s) -
Jennings Lee A.,
Tan Zaldy,
Wenger Neil S.,
Cook Erin A.,
Han Weijuan,
McCreath Heather E.,
Serrano Katherine S.,
Roth Carol P.,
Reuben David B.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14251
Subject(s) - medicine , dementia , reimbursement , family medicine , cohort , health care , nursing , gerontology , disease , economics , economic growth
Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators ( QI s) ranging from 18% to 42%. In response, the University of California at Los Angeles ( UCLA ) Health System created the UCLA Alzheimer's and Dementia Care ( ADC ) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers ( DCM ) working with primary care physicians and community‐based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCM s provide using the Assessing Care of Vulnerable Elders ( ACOVE ‐3) and Physician Consortium for Performance Improvement QI s. Participants included 797 community‐dwelling adults with dementia referred to the UCLA ADC program over a 2‐year period. UCLA is an urban academic medical center with primarily fee‐for‐service reimbursement. The percentage of recommended care received for 17 dementia QI s was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QI s), treatment (6 QI s), and counseling (4 QI s). QI s were abstracted from DCM notes over a 3‐month period from date of initial assessment. Individuals were eligible for 9,895 QI s, of which 92% were passed. Overall pass rates of DCM s were similar (90–96%). All counseling and assessment QI s had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QI s addressing treatments for dementia, which patient‐specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive dementia care comanagement with a nurse practitioner can result in high quality of care for dementia, especially for assessment, screening, and counseling. The effect on treatment QI s is more variable but higher than previous reports of physician‐provided dementia care.