Primary Care Detection of Cognitive Impairment Leveraging Health and Consumer Technologies in Underserved Communities: The MyCog Trial

利用服务欠缺社区的健康和消费技术对认知障碍进行初级保健检测：MyCog 试验

• 批准号: 10709566
• 负责人: CINDY J. NOWINSKI
• 金额: $ 137.37万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-25 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709566
• 关键词: Address; Adult; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care; Award; Behavioral; Black race; Caregivers; Caring; Clinic; Clinical; Cognitive deficits; Communities; Cost Analysis; Decision Making; Dedications; Dementia; Detection; Diagnosis; Disparity; Early Diagnosis; Early identification; Elderly; Electronic Health Record; Ethnic Origin; Etiology; Family; Future; Goals; Health; Health system; Hispanic; Impaired cognition; Latino; Latino Population; Link; Managed Care; Medical; National Institute of Neurological Disorders and Stroke; Neighborhood Health Center; Neurologic; Patient-Centered Care; Patients; Population; Primary Care; Protocols documentation; Quality of life; Race; Randomized; Recommendation; Self Administration; Services; Standardization; Technology; United States National Institutes of Health; Visit; arm; care coordination; cost effectiveness; design; effectiveness testing; evidence base; experience; health disparity; health management; improved; low socioeconomic status; marginalization; marginalized community; medically underserved; member; mild cognitive impairment; patient population; pragmatic trial; primary care practice; primary care provider; primary care setting; primary care visit; public health priorities; racial minority; response; symposium; treatment as usual; trial comparing; underserved community

We seek to renew our current award (UH3NS105562) as part of the Detect CID consortium and conduct a pragmatic trial to test the effectiveness + fidelity of our NIH Toolbox-derived paradigm to improve early detection and management of cognitive impairment/dementia in primary care settings serving health disparate patient populations. Early identification of cognitive impairment (CI), including Alzheimer’s disease (AD) and related dementias (ADRD), is a top public health priority. Yet in primary care settings that manage the health of the majority of community-dwelling older adults, less than half of patients with any CI are detected and/or diagnosed. Among community health centers that serve marginalized patients - by low socioeconomic status (SES), minority race or ethnicity - rates of detection may be far lower. This is of great concern, as Hispanic/Latino (H/L) and Black older adults are 1.5 to 2 times more likely to develop ADRD and to go undetected/undiagnosed compared to non-H/L Whites. Practical, scalable strategies are needed to help primary care practices better detect and manage CI, especially those caring for medically underserved, low SES communities. Since 2017, our team has been a member of the NINDS Detect CID Consortium; a network dedicated to improving clinical paradigms for early detection of CI and ADRD and its subsequent management in everyday clinical settings. Having developed the NIH Toolbox for Assessment of Neurological and Behavioral Function (Co-I: Gershon, MPI: Nowinski) and with expertise in health system re-design for patient-centered care (MPI: Wolf), we validated our own clinical paradigm, known as MyCog. This includes a brief, iPad-based, self- administered, electronic health record (EHR)-linked strategy to assess for CI during primary care visits when concerns are identified. In response to RFA-NS-22-009, we will partner with a national primary care provider (Oak Street Health) and conduct a 2-arm, clinic-randomized, pragmatic trial comparing MyCog to usual care. We will focus on populations experiencing CI/ADRD disparities: Black, H/L, and low SES older adults. Our specific aims are to: 1) test the effectiveness of the MyCog paradigm to improve early detection of CI and dementias among low SES, Black and Hispanic older adults; 2) investigate the presence of disparities in early detection of CI, its diagnosis, and rate of referrals by race and ethnicity; 3) determine the fidelity and reliability of MyCog and identify any patient, caregiver, clinician, and/or health system barriers to its optimal, sustained implementation; 4) assess the cost-effectiveness of the MyCog paradigm from a primary care perspective. Impact: Our findings will address known disparities and offer new evidence on a comprehensive, EHR-enabled, billable, scalable, primary care protocol for early detection of CI - informing future widespread dissemination.

我们寻求更新我们目前的奖项（UH 3 NS 105562）作为检测CID联盟的一部分，并进行一项务实的试验，以测试我们的NIH工具箱衍生范式的有效性+保真度，以改善初级保健环境中认知障碍/痴呆症的早期检测和管理，为健康不同的患者群体提供服务。早期识别认知障碍（CI），包括阿尔茨海默病（AD）和相关痴呆（ADRD），是公共卫生的首要任务。然而，在管理大多数社区居住老年人健康的初级保健环境中，只有不到一半的CI患者被检测和/或诊断。在为社会经济地位低、少数民族或族裔的边缘化患者提供服务的社区卫生中心中，检测率可能要低得多。这是非常令人担忧的，因为西班牙裔/拉丁裔（H/L）和黑人老年人与非H/L白人相比，发生ADRD和未被发现/未被诊断的可能性高出1.5至2倍。需要实用的，可扩展的策略，以帮助初级保健实践更好地检测和管理CI，特别是那些照顾医疗服务不足，低SES社区。自2017年以来，我们的团队一直是NINDS检测CID联盟的成员;该联盟致力于改善CI和ADRD早期检测的临床范例及其在日常临床环境中的后续管理。在开发了NIH神经和行为功能评估工具（Co-I：Gershon，MPI：Nowinski）并拥有以患者为中心的医疗卫生系统重新设计的专业知识（MPI：Wolf）之后，我们验证了我们自己的临床范式，称为MyCog。这包括一个简短的、基于iPad的、自我管理的、与电子健康记录（EHR）相关的策略，用于在确定问题时在初级保健访视期间评估CI。作为对RFA-NS-22-009的回应，我们将与一家国家级初级保健提供商（Oak Street Health）合作，进行一项双臂、临床随机、务实的试验，将MyCog与常规护理进行比较。我们将专注于经历CI/ADRD差异的人群：黑人，H/L和低SES老年人。我们的具体目标是：1）测试MyCog范例在改善低SES、黑人和西班牙裔老年人中CI和痴呆的早期检测的有效性; 2）调查CI的早期检测、其诊断以及按种族和民族的转诊率的差异的存在; 3）确定MyCog的保真度和可靠性，并识别任何患者、护理人员、临床医生和/或卫生系统对其最佳的障碍，持续实施; 4）从初级保健的角度评估MyCog范式的成本效益。影响力：我们的研究结果将解决已知的差异，并提供新的证据，为CI的早期检测提供全面的，EHR支持的，可计费的，可扩展的初级保健协议-为未来的广泛传播提供信息。

项目成果

Primary care detection of cognitive impairment leveraging health and consumer technologies in underserved US communities: protocol for a pragmatic randomised controlled trial of the MyCog paradigm.

• DOI: 10.1136/bmjopen-2023-080101
• 发表时间: 2023-10-18
• 期刊: BMJ OPEN
• 影响因子: 2.9
• 作者: Lovett, Rebecca;Bonham, Morgan;Benavente, Julia Yoshino;Hosseinian, Zahra;Byrne, Greg J.;Diaz, Maria Varela;Bass, Michael;Yao, Lihua;Adin-Cristian, Andrei;Batio, Stephanie;Kim, Minjee;Sluis, Amanda;Moran, Margaret;Buchanan, David R.;Hunt, Justin;Young, Stephanie R.;Gershon, Richard;Nowinski, Cindy;Wolf, Michael
• 通讯作者: Wolf, Michael