Screening for Cognitive Impairment Following Critical Illness: Designing and Testing an Implementation Program to Support High Risk Older Adults

点击翻译按钮获取中文摘要

Palakshappa 1K23AG073529-01 Critical illness leads to incident mild cognitive impairment (MCI) or Alzheimer’s disease and related dementias (ADRD) in many older adults. Roughly 2.5 million older adults are admitted to intensive care units (ICUs) annually in the United States; of those, 1 in 4 have a degree of impairment similar in severity to mild ADRD 12 months after their ICU stay. Recognizing MCI or ADRD following critical illness is crucial for connecting patients and their caregivers with support, providing care recommendations known to decrease the progression of MCI to Alzheimer’s disease (AD), and ultimately improving our understanding of modifiable risk factors that lead to this complication. As such, experts across disciplines recommend screening for MCI or AD following critical illness in high-risk patients; however, this has not been widely adopted. The overall objective of this mentored career development award is to obtain additional training in cognitive assessment and implementation science and use a mixed-methods approach to develop and pilot-test an implementation program to support screening for incident MCI or ADRD following critical illness in older adults. Aim 1 will develop and test a prediction model for incident MCI or AD following critical illness using Medicare claims data and then re-calibrate that model for use in the electronic health record (EHR), providing experiential learning in integrating prediction modeling with EHR data. In Aim 2, I will learn to use qualitative data to inform implementation by identifying facilitators and barriers to implementing cognitive screening specifically in the post-ICU population. In Aim 3, I will gain experience with the design and conduct of a pilot implementation trial and determine the feasibility and potential impact of Anticipating Dementia and Providing Therapy (ADAPT), an implementation program designed to support screening for MCI or ADRD following critical illness in our health system. I will capitalize on the outstanding research environment at Wake Forest School of Medicine as well as the support and guidance of an exceptionally qualified mentorship team (Drs. Williamson, Houston, Hanchate, Birken, Files, Meyer). Through didactic coursework, dedicated mentorship, and hands-on experience, I will obtain the necessary training in the integration of prediction modeling with EHR data, the use of qualitative data to inform implementation, and the design and conduct of a pilot implementation trial. I will also pursue additional training in cognitive assessment methods and geriatric principles, establishing an area of expertise linking critical illness, aging and cognition, and implementation science. This Mentored Patient-Oriented Research K23 will advance our understanding of how best to identify and support older adults with MCI or ADRD after critical illness and it will help me to achieve my long-term goal of becoming an independent physician-scientist dedicated to improving the care we deliver to older adults during and after critical illness.