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

项目摘要 我们的目标是广泛实施和评估一个以用户为中心的、可扩展的、与远程医疗相关的战略 在年度健康访视期间进行认知能力下降的常规检测。认知障碍是 在65岁及以上的成年人中最普遍，但只有不到一半的病例是在初级保健中发现和/或诊断的。 护理机构。现在越来越多的人认为，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， Medicare启动了承保的年度健康访视（AWV），其中包括认知评估，以检测 阿尔茨海默病和相关痴呆（ADRD）。2020年4月，冠状病毒防范 响应补充拨款法案允许医疗保健系统通过远程进行AWV 远程医疗保护因冠状病毒疾病而面临更大不良后果风险的老年患者2019 （COVID-19）.远程医疗作为一种可行的保健提供手段的推广可能会继续下去。而 这为病例发现提供了新的机会，在初级保健中实施AWV，包括如何认知 功能被评估，一直是可变的。临床医生往往依赖于更基本的，“纸”为基础的，采访者- 管理的认知测试，可能不太精确，更繁琐的临床工作流程-影响 早期检测策略的保真度。此外，许多做法缺乏一个明确的协议，转介时，损害 这是一个家庭参与和建立护理目标的过程。实用、可持续、可扩展 迫切需要制定策略，帮助初级保健提供者定期评估认知功能，作为AWV的一部分 (or当怀疑有认知障碍时），确定问题并制定转诊和护理协议 管理 西北大学开发并继续创新NIH神经和神经功能评估工具， Behavioral Function®.自2017年以来，我们的团队与初级保健实践密切合作，制定了一个简短的， 技术支持的，自我管理的，EHR相关的认知评估（MyCog）来自美国国立卫生研究院。 我们还为其使用设计了详细的协议，以及5-7分钟的测试结果如何告知患者护理。我们 我现在提议创建MyCog移动的，以增强、验证和评估管理 进行简短的认知评估，以检测年度健康访视中提供的MCI或AD， 远程医疗 我们的主要目标是：1）使用患者自己的智能手机调整MyCog范式用于远程医疗; 2）。将MyCog移动的应用于年龄在65-85岁之间的现有的、特征良好的和多样化的成年人队列;以及3）。 评估MyCog移动的实施在初级保健实践中的可行性、可接受性和保真度， 为将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.