Development and Validation of the EMR Risk of Alzheimer's and Dementia Assessment Rule (eRADAR)

这项拟议的研究的目标是开发并前瞻性验证阿尔茨海默氏症的EMR风险 和痴呆症评估规则(ERADAR)，这是一个简单的自动化工具，将使用 电子病历(EMR)，以识别可能患有当前的、未诊断的痴呆症的患者。 目前美国有500多万人患有阿尔茨海默氏症和其他痴呆症， 而且只有一半的人被诊断出来。这些患者缺乏诊断可能会导致严重的问题 医疗保健系统和整个社会。未确诊的痴呆症患者更有可能需要 对合并症的紧急护理。他们也更有可能从事危险的行为，如 开车。目前的临床指南建议在#年尽早诊断阿尔茨海默病和痴呆症。 在疾病过程中为患者提供最佳护理。临床医生可以对护理计划进行调整，例如 由于药物治疗方案的简化和家庭成员的更多参与。可以为患者提供 有机会参与规划他们未来的护理需求，通过沟通他们的目标和 首选项和完成先行指令。护理者可以得到更早的支持，这可能会减少 压力和精疲力竭。及时诊断阿尔茨海默病和痴呆症的关键障碍之一是缺乏 临床医生识别高危患者的时间和资源。许多患者没有明显的 认知障碍的症状，特别是在疾病过程的早期，使这些患者难以 在短暂的临床接触中检测到。我们建议通过开发和实现早期诊断来解决这一障碍 前瞻性验证阿尔茨海默氏症和痴呆症的EMR风险评估规则(ERADAR)，该规则将 使用电子病历中的信息(例如未填写的药物、诊所的缺勤情况和痴呆症相关的就诊情况 症状)以检测可能患有当前的、未诊断的痴呆症的患者。我们将使用唯一的数据 综合了美国国家老龄研究所(NIA)的痴呆症发病率数据的金标准来源- 资助的成人思维变化(ACT)研究--5000多名痴呆症患者的前瞻性队列研究 老年人-使用来自团体健康综合医疗保健提供系统的电子病历数据。我们的具体目标 是：1)使用ACT与EMR相关的痴呆症发病率数据开发和内部验证eRADAR 来自Group Health的数据；2)为测试和实施eRADAR制定最佳战略，消息灵通 通过患者、护理人员、临床医生和主要医疗保健系统利益相关者的投入；以及3)前瞻性地 评估eRADAR在团体健康中的准确性、临床试验特点、可行性和可接受性 一项关于对患者护理和临床结果影响的更大规模的临床试验。我们的最终目标是提高产品质量 通过早期发现和最佳护理管理，改善社区痴呆症患者的生活。如果 ERADAR在本研究中被证明是准确和可接受的，它可以作为国家模型来及时地 阿尔茨海默氏症和痴呆症的诊断。

The goal of the proposed study is to develop and prospectively validate the EMR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR), a simple, automated tool that will use information in the electronic medical record (EMR) to identify patients likely to have current, undiagnosed dementia. There are currently more than 5 million people in the U.S. living with Alzheimer’s disease and other dementias, and only half of them have been diagnosed. Lack of diagnosis in these patients can cause major problems for the healthcare system and society at large. Patients with undiagnosed dementia are more likely to need emergency care for comorbid conditions. They also are more likely to engage in risky behaviors such as driving. Current clinical guidelines recommend diagnosis of Alzheimer’s and dementia as early as possible in the disease process to provide patients with optimal care. Clinicians can make adjustments to care plans, such as simplification of medication regimens and greater involvement of family members. Patients can be provided with an opportunity to participate in planning for their future care needs by communicating their goals and preferences and completing advance directives. Caregivers can receive earlier support, which can reduce stress and burnout. One of the key barriers to timely diagnosis of Alzheimer’s disease and dementia is lack of time and resources for clinicians to identify high-risk patients. Many patients do not present with obvious symptoms of cognitive impairment, particularly early in the disease process, making these patients difficult to detect during brief clinical encounters. We propose to address this barrier to early diagnosis by developing and prospectively validating the EMR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR), which will use information in the EMR (such as unfilled medications, clinic ‘no shows’ and visits for dementia-related symptoms) to detect patients who are likely to have current, undiagnosed dementia. We will use a unique data source that combines ‘gold standard’ dementia incidence data from the National Institute on Aging (NIA)- funded Adult Changes in Thought (ACT) study—a prospective cohort study of dementia in more than 5,000 older adults—with EMR data from the Group Health integrated healthcare delivery system. Our Specific Aims are: 1) to develop and internally validate eRADAR using dementia incidence data from ACT linked with EMR data from Group Health; 2) to craft optimal strategies for testing and implementing eRADAR, heavily informed by input from patients, caregivers, clinicians and key healthcare system stakeholders; and 3) to prospectively assess accuracy, clinical test characteristics, feasibility and acceptability of eRADAR in Group Health to inform a larger clinical trial of impact on patient care and clinical outcomes. Our ultimate goal is to improve quality of life in people living in the community with dementia through earlier detection and optimal care management. If eRADAR proves to be accurate and acceptable in this study, it could serve as a national model for timely diagnosis of Alzheimer’s and dementia.