A Cognitive Risk Calculator and Screening tool for Primary Care Settings

项目摘要/摘要 预计到2050年，阿尔茨海默病患者人数将超过8800万。早些时候 检测阿尔茨海默病和相关障碍症状是努力发展的当务之急 疾病修正疗法或干预措施，对最佳病人护理非常重要。目标是 这项建议的目的是提供一种准确、可行和低成本的过程，以促进认知筛查 在人口健康方面。 R61项目的目标是开发和验证两个互补的自动化工具，以确定 并筛查认知能力下降的高危患者。第一个是使用例程的风险计算器 临床数据，以估计患者认知能力下降的风险。60岁及以上的患者将接受 正式的认知测试，以及之前五年例行收集的电子健康记录数据将是 用于模拟认知状态。认知风险计算器将在两个历史样本中进行验证 并集成到电子病历中，以帮助提供者识别脆弱的患者。 第二个工具是经过验证的基于iPad的筛查工具，即认知健康简要评估 (巴赫)患者可以在预约医生之前、期间或之后独立完成。 患者将完成BACH，即蒙特利尔认知评估测试(纸和笔 筛查工具)，以及在两个时间点进行正式的神经心理测试。我们假设巴赫 将比现有的筛查工具对认知变化更敏感。巴赫是 已集成到Epic电子病历平台；认知评分和筛查 抑郁、压力和睡眠中断的结果会自动记录在患者的医疗记录中 供提供者记录和操作的记录。 R33项目是一项第四阶段的实用临床试验，以衡量这些工具在 初级保健实践。随着时间的推移，六家内科诊所将被随机分配到积极研究中 ARM(风险计算器和巴赫)。这将允许比较护理筛查的标准做法 在介绍认知风险计算器和巴赫之后，进行筛选活动。我们将使用 确定各种实践中最佳实施策略的混合方法 模特们。 影响：EHR风险计算器和BACH有能力改进认知能力下降的检测 从人口健康的角度来看。该项目还考察了社会经济领域的地区差异 优势与以认知风险和筛查态度衡量的健康差距有关 以及提供者和患者双方的行为。

PROJECT SUMMARY/ABSTRACT The number of people with Alzheimer’s disease is expected to exceed 88 million by 2050. Early detection of Alzheimer’s disease and related disorders symptoms are imperative for efforts to develop disease modifying therapies or interventions, and are important for optimal patient care. The objective of this proposal is to provide an accurate, feasible, and low-cost process to facilitate cognitive screening in population health. The aims of the R61 project are to develop and validate two complementary, automated tools to identify and screen patients at high risk for cognitive decline. The first is a risk calculator that uses routine clinical data to estimate patients’ risk for cognitive decline. Patients 60 years and older will undergo formal cognitive testing, and five prior years of routinely-collected electronic health record data will be used to model cognitive status. The Cognitive Risk Calculator will be validated in two historical samples and integrated into the electronic medical record to help providers identify vulnerable patients. The second tool is a validated iPad-based screening tool, the Brief Assessment of Cognitive Health (BACH) that patients can complete independently before, during, or after their doctor appointment. Patients will complete the BACH, the Montreal Cognitive Assessment Test (a paper-and-pencil screening tool), and formal neuropsychological testing at two time points. We hypothesize the BACH will be more sensitive to cognitive change over time than the established screening tool. The BACH is already integrated into the Epic electronic medical record platform; cognitive score and screening results for depression, stress, and sleep disruption are automatically recorded in the patient’s medical record for providers to document and act upon. The R33 project is a Phase IV pragmatic clinical trial to gauge the uptake and utility of these tools in primary care practices. Six internal medicine clinics will be randomized over time to the active study arm (Risk Calculator and BACH). This will permit comparisons of standard of care screening practices with screening activities following introduction of the Cognitive Risk Calculator and BACH. We will use a mixed-methods approach to determine optimal implementation strategies across a variety of practice models. Impact: The EHR risk-calculator and BACH have the capacity to improve detection of cognitive decline on a population health scale. The project also examines how regional differences in socioeconomic advantage relate to health disparities measured in terms of cognitive risk as well as screening attitudes and behaviors on the part of both providers and patients.