Development and Validation of the EMR Risk of Alzheimer's and Dementia Assessment Rule (eRADAR)

这项研究的目的是开发和前瞻性验证阿尔茨海默氏症的EMR风险 和痴呆症评估规则（eRADAR），这是一个简单的自动化工具，将使用 电子病历（EMR），以识别可能患有当前未诊断的痴呆症的患者。 目前美国有超过500万人患有阿尔茨海默病和其他痴呆症， 只有一半人被确诊这些患者缺乏诊断可能会导致严重的问题， 医疗系统和整个社会。未确诊的痴呆症患者更可能需要 共病的紧急护理。他们也更有可能从事危险的行为，如 开车目前的临床指南建议尽早诊断阿尔茨海默氏症和痴呆症， 为患者提供最佳护理。临床医生可以对护理计划进行调整，例如 如简化药物治疗方案和家庭成员的更多参与。患者可以提供 有机会通过沟通他们的目标， 偏好和完成预先指示。照顾者可以得到更早的支持，这可以减少 压力和倦怠。及时诊断阿尔茨海默病和痴呆症的关键障碍之一是缺乏 为临床医生识别高风险患者提供时间和资源。许多患者没有明显的 认知障碍的症状，特别是在疾病过程的早期，使这些患者难以 在短暂的临床遭遇中发现。我们建议通过开发和 前瞻性验证阿尔茨海默病和痴呆症评估规则（eRADAR）的EMR风险， 使用EMR中的信息（如未填写的药物，诊所“未显示”和痴呆症相关的访问） 症状），以检测可能患有当前未诊断的痴呆症的患者。我们将使用独特的数据 来源，结合“金标准”痴呆症发病率数据从国家老龄化研究所（NIA）- 受资助的成人思维变化（ACT）研究-一项对5000多名痴呆症患者进行的前瞻性队列研究 老年人-使用Group Health集成医疗保健交付系统的EMR数据。我们的具体目标 1）使用ACT与EMR相关的痴呆发病率数据开发和内部验证eRADAR 来自Group Health的数据; 2）制定测试和实施eRADAR的最佳策略， 通过患者、护理人员、临床医生和关键医疗保健系统利益相关者的输入;以及3）前瞻性地 评估eRADAR在团体健康中的准确性、临床测试特征、可行性和可接受性， 一个更大的临床试验对病人护理和临床结果的影响。我们的最终目标是提高质量， 通过早期发现和最佳护理管理，改善社区痴呆症患者的生活。如果 在这项研究中，eRADAR被证明是准确和可接受的，它可以作为一个国家模型， 阿尔茨海默氏症和痴呆症的诊断。

The goal of the proposed study is to develop and prospectively validate the EMR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR), a simple, automated tool that will use information in the electronic medical record (EMR) to identify patients likely to have current, undiagnosed dementia. There are currently more than 5 million people in the U.S. living with Alzheimer’s disease and other dementias, and only half of them have been diagnosed. Lack of diagnosis in these patients can cause major problems for the healthcare system and society at large. Patients with undiagnosed dementia are more likely to need emergency care for comorbid conditions. They also are more likely to engage in risky behaviors such as driving. Current clinical guidelines recommend diagnosis of Alzheimer’s and dementia as early as possible in the disease process to provide patients with optimal care. Clinicians can make adjustments to care plans, such as simplification of medication regimens and greater involvement of family members. Patients can be provided with an opportunity to participate in planning for their future care needs by communicating their goals and preferences and completing advance directives. Caregivers can receive earlier support, which can reduce stress and burnout. One of the key barriers to timely diagnosis of Alzheimer’s disease and dementia is lack of time and resources for clinicians to identify high-risk patients. Many patients do not present with obvious symptoms of cognitive impairment, particularly early in the disease process, making these patients difficult to detect during brief clinical encounters. We propose to address this barrier to early diagnosis by developing and prospectively validating the EMR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR), which will use information in the EMR (such as unfilled medications, clinic ‘no shows’ and visits for dementia-related symptoms) to detect patients who are likely to have current, undiagnosed dementia. We will use a unique data source that combines ‘gold standard’ dementia incidence data from the National Institute on Aging (NIA)- funded Adult Changes in Thought (ACT) study—a prospective cohort study of dementia in more than 5,000 older adults—with EMR data from the Group Health integrated healthcare delivery system. Our Specific Aims are: 1) to develop and internally validate eRADAR using dementia incidence data from ACT linked with EMR data from Group Health; 2) to craft optimal strategies for testing and implementing eRADAR, heavily informed by input from patients, caregivers, clinicians and key healthcare system stakeholders; and 3) to prospectively assess accuracy, clinical test characteristics, feasibility and acceptability of eRADAR in Group Health to inform a larger clinical trial of impact on patient care and clinical outcomes. Our ultimate goal is to improve quality of life in people living in the community with dementia through earlier detection and optimal care management. If eRADAR proves to be accurate and acceptable in this study, it could serve as a national model for timely diagnosis of Alzheimer’s and dementia.