A novel platform to facilitate provider adoption of cognitive care planning

总结 阿尔茨海默氏病和阿尔茨海默氏病及相关痴呆（AD/ADRD）是阿尔茨海默病患者中的进行性疾病。 患者的身体和认知能力会随着时间的推移急剧下降。虽然目前还没有 治愈和非常少的药物为基础的治疗选择，一些干预措施可以帮助改善患者 健康和生活质量。认知护理计划（CCP）是指系统地编制和 向AD/ADRD患者传达个性化的后续护理建议和指导。这 活动可以导致更好的护理管理，从而有益于患者的健康和福祉， 他们的照顾者。尽管如此，CCP在常规护理中很少见到，并且有几个障碍归因于缓慢的 采用率。首先，CCP是耗时的，因为要组装大量的内容;认知 评估数据、情绪健康状况和护理人员知识，仅举几例。第二，专业知识 需要解释患者信息并生成个性化的护理建议可能令人望而生畏 非专家;而由于缺乏痴呆症专家，照顾这个病人的负担 福尔斯最常求助于非专科初级保健医生（PCP）。投入的大量时间 制定护理计划也会导致财务障碍。在2018年，建立了一个新的计费代码， 解决这一问题，但偿还率仍然很低。 BrainCheck的总体目标是加强正式CCP的采用，作为常规护理的一部分， AD/ADRD患者。我们已经开发了一个基于应用程序的工具，它集成了评估分数，提供者输入， 以及患者/护理者报告的数据，以生成要递送的个性化的、易于阅读的文档 在一次诊所访问中。该工具的原型BC-Care™得到了最初一组专家的积极认可， 和非专业用户，他们的反馈被用来解释关键功能和用户界面设计。 此外，临床实践报告说，在使用BC-Care后，申请医疗保险报销的成功率更高。 基于这项初步工作，我们相信BC-Care使护理计划更快，更容易获得， 很可能会得到补偿。在这里，我们提出了II期研究，以系统地验证BC-Care对 采用CCP。具体而言，我们将：衡量花费在护理计划上的时间，护理计划完成率， 和使用BC-Care的提供者的报销成功率（目标1）;比较提供者 在获得BC-Care工具之前和之后采用护理规划（目标2）;并跟踪 通过BC-Care接受护理计划的患者和护理人员的健康和福祉与 接受常规护理（目标3）。 通过解决三个主要障碍，阻止提供者提供护理计划服务， 对于AD/ADRD患者，我们预测我们的技术解决方案将大大提高采用率， 通过改善常规认知护理方法来改善健康和福祉的现实途径。

SUMMARY Alzheimer's Disease and Alzheimer's Disease and Related Dementias (AD/ADRD) are progressive diseases in which patients’ physical and cognitive abilities decline precipitously over time. Although there is currently no cure and very few pharmaceutical-based treatment options, some interventions can help improve patient health and quality of life. Cognitive care planning (CCP) refers to the practice of systematically compiling and communicating personalized recommendations and directions for follow-up care to AD/ADRD patients. This activity can lead to better care management, thus benefiting the health and well-being of both patients and their caregivers. Despite this, CCP is scarcely seen in routine care and several barriers attribute to the slow adoption rate. First, CCP is time consuming due to the sizable amount of content to assemble; cognitive assessment data, emotional health status, and caregiver knowledge, to name a few. Second, the expertise required to interpret patient information and generate individualized recommendations for care can be daunting to non-specialists; whereas due to a shortage of dementia specialists, the burden of care for this patient population most often falls to non-specialist primary care physicians (PCPs). The considerable time invested into developing a care plan results in a financial barrier as well. In 2018 a new billing code was established to address this but reimbursements rates remain low. BrainCheck has an overarching goal to enhance the adoption of formal CCP as part of routine care for AD/ADRD patients. We have developed an app-based tool that integrates assessment scores, provider input, and patient/caregiver reported data to generate an individualized, easy-to-read document to be delivered during a clinic visit. A prototype of this tool, BC-Care™, was positively received by an initial group of specialist and non-specialist users and their feedback was used to iterate on key features and user interface design. Moreover, clinical practices reported greater success in claiming Medicare reimbursement after using BC-Care. Based on this preliminary work, we believe BC-Care makes care planning faster, more accessible, and more likely to be reimbursed. Here, we propose Phase II studies to systematically validate the impact of BC-Care on the adoption of CCP. Specifically, we will: measure the time spent on care planning, care plan completion rate, and reimbursement success rate for providers using BC-Care (Aim 1); compare the extent to which providers adopt care planning before and after gaining access to the BC-Care tool (Aim 2); and track specific impacts on health and well-being among patients and caregivers who received a care plan via BC-Care compared to those receiving care-as-usual (Aim 3). By addressing three of the major barriers preventing providers from offering care planning services to their patients with AD/ADRD, we predict our technological solution will substantially enhance adoption, thus offering a realistic path toward improving health and well-being by improving the approach to routine cognitive care.