Development and Validation of a Telehealth Strategy for Routine Detection of Cognitive Impairment in Primary Care: The MyCog Mobile Assessment

项目总结 我们的目标是广泛实施和评估以用户为中心、可扩展的远程医疗链接策略 用于在年度健康访问期间进行认知能力下降的常规检测。认知障碍是 最常见的是65岁及以上的成年人，但只有不到一半的病例是在初级保健中发现和/或诊断的 护理设置。现在越来越多的人承认，早期发现对于优化护理计划至关重要， 持续的独立性，慢性病的管理和适当的照顾者参与。2011年， 联邦医疗保险启动了一项覆盖的年度健康访问(AWV)，其中包括一项认知评估，以检测 损害、阿尔茨海默病和相关痴呆(ADRD)。2020年4月，冠状病毒防备 和响应补充拨款法案允许医疗系统通过以下方式远程操作AWV 远程医疗，以保护因冠状病毒疾病2019年出现不良后果风险更大的老年患者 (新冠肺炎)。远程医疗作为一种可行的医疗保健提供手段的扩张可能会继续下去。而当 这为发现病例、在初级保健中实施AWV提供了新的机会，包括如何认知 功能是评估的，一直是可变的。临床医生通常依赖于更基本的、以纸张为基础的面谈- 管理认知测试，这些测试可能不那么精确，对临床工作流程更加繁琐-影响 早期发现策略的保真度。此外，许多做法缺乏明确的转介协议，当损害时 是确定的，以及家庭参与和建立护理目标的过程。实用、可持续、可扩展 迫切需要策略来帮助初级保健提供者将认知功能作为AWV的一部分进行常规评估 (或每当怀疑认知障碍时)，确定问题并制定转诊和护理方案 管理层。 西北大学开发并继续创新美国国立卫生研究院神经病学和神经病学评估工具箱 行为功能®。自2017年以来，我们的团队与初级保健实践密切合作，制定了一份简要的、 源自NIH工具箱的技术支持的、自我管理的、与EHR相关的认知评估(MyCog)。 我们还设计了一个详细的使用方案，以及5-7分钟的测试结果如何为患者护理提供信息。我们 现在建议创建MyCog Mobile，以增强、验证和评估管理 在年度健康访问期间进行简短的认知评估，以检测MCI或AD 远程医疗。 我们的主要目标是：1)使MyCog范例适用于使用患者自己的智能手机的远程医疗； 2)。在年龄在65-85岁之间的现有、特征良好且多样化的成年人队列中验证MyCog Mobile；和3)。 评估MyCog Mobile在初级保健实践中实施的可行性、可接受性和保真度 为未来的大规模测试做准备。

PROJECT SUMMARY Our objective is to widely implement and evaluate a user-centered, scalable, telemedicine - linked strategy for the routine detection of cognitive decline during the Annual Wellness Visit. Cognitive impairment is most prevalent among adults 65 and older, yet less than half of cases are detected and/or diagnosed in primary care settings. It is now increasingly accepted that early detection is critically important to optimize care planning, sustained independence, management of chronic conditions and appropriate caregiver involvement. In 2011, Medicare initiated a covered, Annual Wellness Visit (AWV) that includes a cognitive assessment to detect impairment, Alzheimer’s disease and related dementias (ADRD). In April 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act allowed healthcare systems to conduct AWVs remotely via telemedicine to protect older patients at greater risk of adverse outcomes due to the coronavirus disease 2019 (COVID-19). The expansion of telemedicine as a viable means of healthcare deliver is likely to continue. While this presents new opportunities for case finding, implementation of AWVs in primary care, including how cognitive function is assessed, has been variable. Clinicians often rely on more basic, “paper”-based, interviewer- administered cognitive tests that may be less precise and more cumbersome to clinical workflow – affecting the fidelity of an early detection strategy. Further, many practices lack a clear protocol for referral when impairment is determined, and a process for family involvement and establishing care goals. Practical, sustainable, scalable strategies are urgently needed to help primary care providers routinely assess cognitive function as part of AWVs (or whenever a cognitive impairment is suspected), identify concerns and have a protocol for referrals and care management. Northwestern developed and continues to innovate the NIH Toolbox for the Assessment of Neurological and Behavioral Function®. Since 2017, our team has worked closely with primary care practices to develop a brief, technology-enabled, self-administered, EHR-linked cognitive assessment (MyCog) derived from the NIH Toolbox. We also devised a detailed protocol for its use and how results of a 5-7 minute test, can inform patient care. We now propose creating MyCog Mobile to enhance, validate and evaluate the feasibility of the administration of a brief cognitive assessment to detect MCI or AD delivered within an Annual Wellness visit conducted via telemedicine. Our primary aims are to: 1) Adapt the MyCog paradigm for use in telemedicine using patients’ own smartphones; 2). Validate MyCog Mobile in an existing, well-characterized and diverse cohort of adults ages 65-85; and 3). Evaluate the feasibility, acceptability, and fidelity of MyCog Mobile implementation in a primary care practice as preparation for future large-scale testing.