Barriers to early identification of dementia in a safety net healthcare system

项目摘要 认知障碍和痴呆症的早期识别与多种公共卫生益处相关， 如果阿尔茨海默病的疾病改善疗法得到广泛应用， available.然而，延迟或错过痴呆症的识别是常见的，特别是在种族/民族之间。 少数群体和社会经济背景不利的人。对这一延迟的可能解释 可能包括患者对痴呆症的信念，例如它是衰老过程的一部分或对相关疾病的恐惧。 耻辱;相反，提供者或卫生系统一级的障碍可能妨碍及时的诊断检查。 这项混合方法研究的总体目标是确定早期识别痴呆症的障碍 在安全网卫生系统中接受医疗保健的老年人。我们假设两个病人 健康系统水平的因素与该患者群体中痴呆症诊断的延迟相关。 我们将首先确定是否决定寻求评估的记忆症状，通过假设评估 临床情景，与一个人的痴呆症特定的健康素养调整后， 人口因素和健康状况。然后，我们将评估患者是否自我报告记忆症状， 国家规定的预防保健访问与接受诊断评估的可能性较高相关 对于痴呆症，使用独特的电子健康记录衍生数据集进行评估。我们将补充 分析的目的是与患者和护理人员进行半结构化访谈，以确定护理障碍， 记忆障碍以及未满足的需求。这项研究将有助于确定具体的障碍，可以针对 未来的干预措施，以改善安全网人口中痴呆症的早期识别。

Project Summary Early identification of cognitive impairment and dementia is associated with multiple public health benefits and will become even more important if a disease-modifying treatments for Alzheimer’s disease becomes widely available. However, delayed or missed identification of dementia is common, particularly among racial/ethnic minorities and those from socioeconomically disadvantaged backgrounds. Possible explanations for this delay may include patient beliefs about dementia such as it being part of the aging process or fear of associated stigma; conversely, barriers at the level of provider or health-system may hinder timely diagnostic workup. The overall goal of this mixed-methods study is to identify barriers to early identification of dementia for older adults who receive healthcare in a safety net health system. We hypothesize that both patient and health-system level factors are associated with delay in dementia diagnosis within this patient population. We will first determine if the decision to seek evaluation for memory symptoms, assessed through hypothetical clinical scenarios, is associated with a person’s dementia-specific health literacy after adjusting for demographic factors and health status. We will then evaluate if patient self-report of memory symptoms on a state-mandated preventive care visit is associated with a higher likelihood of undergoing diagnostic evaluation for dementia, assessed using a unique electronic health record-derived dataset. We will complement the analytic aims with semi-structured interviews with patients and caregivers to identify barriers to care for memory disorders as well as unmet needs.This study will help identify specific barriers that can be targeted for future interventions to improve early identification of dementia in the safety net population.