Primary care detection of cognitive impairment leveraging health and consumer technologies in underserved US communities: protocol for a pragmatic randomised controlled trial of the MyCog paradigm.
Primary care detection of cognitive impairment leveraging health and consumer technologies in underserved US communities: protocol for a pragmatic randomised controlled trial of the MyCog paradigm.
复制标题
DOI：
10.1136/bmjopen-2023-080101
复制
发表时间：
2023-10-18
期刊：
影响因子：
2.9
通讯作者：
Wolf, Michael
中科院分区：
文献类型：
--
作者：
Lovett, Rebecca;Bonham, Morgan;Benavente, Julia Yoshino;Hosseinian, Zahra;Byrne, Greg J.;Diaz, Maria Varela;Bass, Michael;Yao, Lihua;Adin-Cristian, Andrei;Batio, Stephanie;Kim, Minjee;Sluis, Amanda;Moran, Margaret;Buchanan, David R.;Hunt, Justin;Young, Stephanie R.;Gershon, Richard;Nowinski, Cindy;Wolf, Michael
关键词：
早期识别认知障碍(CI)，包括阿尔茨海默病和相关痴呆(ADRD)，是公共卫生的首要任务。然而，CI/ADRD在初级保健环境中和在健康状况不同的人群中往往未被发现和诊断不足。MyCog范式是一种基于iPad的、自我管理的、经过验证的认知评估，基于美国国立卫生研究院(NIH)工具箱认知电池，并结合临床医生决策支持工具，专为在不同的初级保健环境中检测CI/ADRD而量身定做。我们将在不同地理位置的橡树街健康中心进行一项双臂初级保健实践随机(N=24项实践；拟议实践中的45 257名活跃患者)的务实试验，以测试MyCog范式的有效性，与常规护理相比，MyCog范式在低社会经济、黑人和西班牙裔老年人中改善CI/ADRD的早期发现。随机分配到干预组的参与实践将在3年的实施期内将MyCog范例作为新的护理标准；作为年度健康访问的认知组件，以及任何患者/告密者报告或医疗保健提供者怀疑的认知关切。发现(认知测试建议损害)和/或诊断(相关的国际疾病分类-9/10[ICD-9/10]代码)认知缺陷、损害或痴呆(包括ADRD)的比率将是我们在不同武器之间进行比较的主要研究结果。次要结果将包括ADRD的严重程度(即轻度或后期)、与认知相关的转介率以及家庭成员或照顾者参与ADRD护理计划的比率。我们将使用广义线性混合模型来说明集群研究设计。二次模型将根据主题、诊所或访问的特定特征进行调整。我们将使用混合方法来检查MyCog范式的保真度和成本效益。Advarra的机构审查委员会已经批准了研究方案(Pro00064339)。研究结果将发表在同行评议的期刊上，摘要将提供给该研究的资助者。NCT05607732。
Early identification of cognitive impairment (CI), including Alzheimer’s disease and related dementias (ADRD), is a top public health priority. Yet, CI/ADRD is often undetected and underdiagnosed within primary care settings, and in health disparate populations. The MyCog paradigm is an iPad-based, self-administered, validated cognitive assessment based on the National Institutes of Health (NIH) Toolbox Cognition Battery and coupled with clinician decision-support tools that is specifically tailored for CI/ADRD detection within diverse, primary care settings. We will conduct a two-arm, primary care practice-randomised (N=24 practices; 45 257 active patients at the proposed practices), pragmatic trial among geographically diverse Oak Street Health sites to test the effectiveness of the MyCog paradigm to improve early detection CI/ADRD among low socioeconomic, black and Hispanic older adults compared with usual care. Participating practices randomised to the intervention arm will impart the MyCog paradigm as a new standard of care over a 3-year implementation period; as the cognitive component for Annual Wellness Visits and for any patient/informant-reported or healthcare provider-suspected cognitive concern. Rates of detected (cognitive test suggesting impairment) and/or diagnosed (relevant International Classification of Diseases-9/10 [ICD-9/10] code) cognitive deficits, impairments or dementias including ADRD will be our primary outcome of study compared between arms. Secondary outcomes will include ADRD severity (ie, mild or later stage), rates of cognitive-related referrals and rates of family member or caregiver involvement in ADRD care planning. We will use generalised linear mixed models to account for clustered study design. Secondary models will adjust for subject, clinic or visit-specific characteristics. We will use mixed-methods approaches to examine fidelity and cost-effectiveness of the MyCog paradigm. The Institutional Review Board at Advarra has approved the study protocol (Pro00064339). Results will be published in peer-reviewed journals and summaries will be provided to the funders of the study. NCT05607732.
登录
查看更多内容
影响因子：
2.1
作者：
Bradford A;Kunik ME;Schulz P;Williams SP;Singh H
通讯作者：
Singh H
DOI：
10.1111/j.1532-5415.2005.53569.x
发表时间：
2005-11-01
影响因子：
6.3
作者：
Clark, PC;Kutner, NG;Bowles, T
通讯作者：
Bowles, T
影响因子：
14
作者：
通讯作者：
--
初级保健临床医生对有多种疾病的老年人进行治疗决策的经验。
影响因子：
--
作者：
Fried, Terri R.;Tinetti, Mary E.;Iannone, Lynne
通讯作者：
Iannone, Lynne
影响因子：
4
作者：
Gale NK;Heath G;Cameron E;Rashid S;Redwood S
通讯作者：
Redwood S