A Pragmatic Trial of the UCSF Brain Health Assessment for the Detection of Cognitive Impairment in Primary Care

加州大学旧金山分校脑健康评估用于检测初级保健中认知障碍的实用试验

• 批准号: 10524698
• 负责人: Katherine Laurel Possin
• 金额: $ 162.41万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10524698
• 关键词: Address; African American; Age; Aging; Algorithms; Alzheimer' s Disease; Asian Pacific Islander; Behavioral Symptoms; Black race; California; Caring; Clinic; Cluster randomized trial; Cognitive; Communities; Consultations; Dementia; Detection; Diagnosis; Diagnostic; Disclosure; Early Diagnosis; Economics; Elderly; Epidemiology; Family; Frequencies; Funding; Future; Goals; Gold; Healthcare; Hispanic; Impaired cognition; Impairment; Integrated Health Care Systems; Language; Latino; Limited English Proficiency; Medical; Medicare; Memory; Neuropsychology; Nurses; Outcome; Pathway interactions; Patients; Penetration; Persons; Population; Population Heterogeneity; Primary Health Care; Provider; Randomized; Research; Resources; Risk; San Francisco; Specialist; Specificity; Standardization; Surveys; Tablet Computer; Tablets; Testing; Time; Universities; Visuospatial; Work; base; brain health; care outcomes; cognitive testing; cohort; comorbidity; comparison group; cost; design; diagnosis standard; education resources; effectiveness evaluation; ethnic diversity; ethnic minority; experience; follow-up; functional decline; health assessment; health care disparity; health disparity; health disparity populations; health equity; implementation barriers; implementation science; implementation strategy; improved; informant; medical specialties; member; neighborhood disadvantage; neurocognitive disorder; novel; novel strategies; payment; pragmatic trial; precision medicine; primary outcome; racial and ethnic; racial and ethnic disparities; skills; social determinants; social health determinants; statistics; telehealth; treatment as usual; treatment effect; user-friendly

Efficient and user-friendly paradigms to detect cognitive impairment, including dementia are needed in primary care. The UCSF Brain Health Assessment accurately detects cognitive impairment via an appealing tablet interface with automated scoring and EMR integration. With the first round of funding, we validated the paradigm in English and Spanish speakers, developed regression-based norms that accurately classify patients by their likelihood of impairment, identified racial and ethnic disparities and barriers to brain health care, and at UCSF primary care the paradigm increased diagnosis rates by 40%. The primary goals of the proposed work are to evaluate the effectiveness of the paradigm for improving brain health care via a large pragmatic trial, to address challenges to implementation, and to pioneer precision medicine approaches to reference group adjustments. In Aim 1, we will conduct a pragmatic cluster randomized trial in 26 Kaiser Southern California primary care clinics to determine the effectiveness of the paradigm on detection rates and other brain health outcomes. In Aim 2, we will identify and address challenges to implementation and sustainability. In Aim 3, we will further diversify our well-characterized reference group and refine our detection algorithms to adjust for social determinants of brain health (not race), which is novel and also critical for a paradigm to be appropriate for all members of the increasingly diverse U.S. older adult population. If successful, this work will produce a validated paradigm that is available to address the unmet need to detect cognitive impairment, including dementia, in large and diverse populations seen in primary care, and provide useful information about wide scale implementation of the paradigm to mitigate healthcare disparities and improve brain health care.

在初级保健中需要有效且用户友好的范例来检测认知障碍，包括痴呆症。 UCSF大脑健康评估通过具有自动评分和EMR集成的吸引力的平板电脑界面准确地检测出认知障碍。在第一轮资金的情况下，我们验证了英语和西班牙语者的范式，开发了基于回归的规范，这些规范可以通过障碍的可能性准确地对患者进行分类，确定的种族和种族差异以及对大脑保健的障碍，在UCSF初级保健中，范式将范例提高了40％。拟议工作的主要目标是通过大型务实试验评估范式改善脑保健的有效性，以应对实施挑战，并为参考小组调整提供先驱精密医学方法。在AIM 1中，我们将在26个KAISER南加州初级保健诊所进行务实的聚类随机试验，以确定范式对检测率和其他大脑健康结果的有效性。在AIM 2中，我们将确定并应对实施和可持续性的挑战。在AIM 3中，我们将进一步多样化我们的特征良好的参考小组，并完善我们的检测算法，以适应大脑健康的社会决定因素（不是种族），这对于范式来说是新颖的，对于范式来说，适合美国日益多样化的美国老年人的所有成员。如果成功的话，这项工作将产生经过验证的范式，可用于解决在初级保健中看到的大量和多样性人群中检测认知障碍（包括痴呆症）的未满足需求，并提供有关缓解范式实施大规模实施的有用信息，以减轻医疗保健差异并改善大脑保健。