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

项目摘要 早期识别认知障碍和痴呆症与多种公共健康益处和 如果阿尔茨海默病的疾病修饰疗法得到广泛应用，将变得更加重要 可用。然而，延迟或漏诊痴呆症是很常见的，特别是在种族/民族中。 少数群体和社会经济条件较差的人。对这种延迟的可能解释 可能包括患者对痴呆症的看法，如它是衰老过程的一部分，或者害怕与 耻辱；相反，提供者或卫生系统一级的障碍可能会阻碍及时的诊断检查。 这项混合方法研究的总体目标是找出痴呆症早期识别的障碍。 适用于在安全网医疗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有关。 我们将首先确定是否决定寻求记忆症状的评估，通过假设进行评估 临床情景，与调整后的痴呆症特定健康素养有关 人口因素和健康状况。然后我们将评估患者对记忆症状的自我报告是否 国家规定的预防性护理访问与接受诊断性评估的可能性更高相关 对于痴呆症，使用独特的电子健康记录派生数据集进行评估。我们将补充 分析的目的是通过与患者和照顾者的半结构化访谈来确定护理障碍 记忆障碍以及未得到满足的需求。这项研究将有助于确定可以针对的特定障碍 未来的干预措施，以改善安全网人群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.