Health Promotion and Disease Prevention Research Centers

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ABSTRACT: AZ-KAER: Applying the KAER Model in Banner Health, Tucson Arizona The long-term outcome of the project, “Applying the KAER Model to Primary Care within Banner University Medicine” is to advise future implementation of the KAER (Kickstart, Assess, Evaluate, Refer) model across primary care sites in order to improve the detection, diagnosis and management of cognitive impairment among older adults, and connect people in need with community-based support and services. The broad project specific aims are to: 1) increase the number of older adults who receive standard assessment, evaluation and referral for cognitive impairment by their primary care providers (PCPs); 2) increase the dependability of provider use of the KAER model in areas of acceptability, ease of use and effectiveness; and 3) increase likelihood of future model adoption in other health systems. Alzheimer's disease (or a related dementia) (ADRD) is an increasingly important public health issue because the burden is large, the impact is major, and there are ways common public health tools and techniques can mitigate the impact. Although ADRD is relatively commonly seen by PCPs, numerous studies show that less than half of older patients with cognitive impairment received the diagnosis from their primary care providers. The purpose of this project is to increase the capacity of PCPs to systematically and efficiently incorporate evidence-based diagnostic strategies into their existing treatment protocols. Through a collaboration with the Arizona Prevention Research Center, the University of Arizona Center on Aging, Banner Alzheimer's Institute, and Banner University Medicine's Primary Care Service Line, this project will implement, evaluate and refine the KAER toolkit within a primary care setting within Banner Health. Physicians and nurse practitioners in general internal medicine and family & community medicine clinics will be given tools to evaluate for potential cognitive impairment and refer those with impairment to relevant community services and supports. After a short developmental phase guided by the principles of Participatory Action Research, the project will use a quasi-experimental, pre-post design to examine acceptability, feasibility and effectiveness of model implementation, assess and refine the model for gaps and areas for improvement, and disseminate results. The project team brings expertise in geriatrics, cognitive impairment, public health, evaluation, clinical administration and operations. The Banner clinics serve a target population (comparable to the US population) that is older, ~30% Hispanic, and 3% Native American, thus testing the KAER model among diverse patients. Banner Health is one of the largest non-profit health systems in the US and provides the opportunity to disseminate the refined KAER model across the Banner system and beyond.