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Henry Ford Health System Always Events
 

Henry Ford Health System Always Events

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    Henry Ford Health System Always Events Henry Ford Health System Always Events Presentation Transcript

    • Henry Ford Health SystemDementia Screening for Senior Patients
    • Picker Awards“Understanding and respectingpatients’ values, preferences,  Picker awards established in 2003and expressed needs is thefoundation of patient-centered  Independent nonprofitcare” Harvey Picker  Patient-centered care Founder 1915-2008  Improvement of patient’s experience and interaction with health care providers  Picker Surveys are the world standard for measuring performance “through the patient’s eyes”
    •  World Health Organization If the costs of AD were a  Significant threat to health of all nations world economy,  First chronic disease to be cited it would rank as Dementia as Chronic Disease the 13th largest  Genetic vulnerability & environmental exposure  Importance of risk factor modification ▪ Disease modification National Alzheimer’s Association  Pre-dementia states ▪ Mild Cognitive impairment ▪ Pre-clinical AD AD  Earliest stages are target of treatment National Alzheimer’s Project Grant Medicare Wellness Visit  Patients must be asked about cognition at an annual visit
    •  Dispel the mythology of memory loss with aging  “Normal” age related cognitive decline is not normal Make the Diagnosis  Alzheimer’s Disease?  Lewy Body Disease?  Frontal Dementia? Care vs Cure Disease modification strategies Family as patient Community Alliances
    •  Current norms  New treatments target outdated preclinical states  MCI  Biomarkers and risk  Preclinical changes factor identification Neuropsych tests  Serial testing (within change late in course subjects) more powerful  NP testing normal in to predict pathology brains with AD changes ▪ Need office easy to administer office based tool  Normal NP test does not ▪ Repeat regularly as part of health mean brain is normal maintenance  Second to last biomarker to change
    •  Lack of time for assessment Uncertainty regarding diagnostics Complexity of cognitive testing Lack of resources for management of behavioral and social issues, community resources, caregiver training Henry Ford Hospital
    •  Routine dementia screening annually, starting at age 70 Internet tools for cognitive and behavioral assessments Identify a specific dementia syndrome Provide appropriate medical and non-medical treatments Align patient and caregiver with network of community supports
    • NIH Toolbox NeuroQualPublic domain web-basedassessments Computerized 30 minutes Scoring and interpretationOversight by supportpersonnelIdentifies MCI, AD, non-AD Behavior assessment Caregiver distress
    • Accessed through CarePlusGuides diagnostic history, physical exam, tests, and treatmentIdentifies red flags for referralDirect link on CarePlus for Neurology referral if needed
    • Education Grosfeld BehaviorCollaborative management Community referrals All are referred Direct link on careplus Located at HFH
    • June 1-Sept 30 Oct 1-Nov 30 Dec 1-Feb 28 Mar 1-May 31 Development Training Pilot EvaluationRefine web based tools Physician  Every patient >/= 70 Computerized screenInterpretive component Support personnel screened in 2 clinics for patients >/=70Designate space in Social workers Database collection Screening labseach clinic for testing Meet with advisory Meet with advisory MRI (or CT) brainPurchase computers group group Specific diagnosisIT issues Cholinesterase inhibitorPatient advisory group for AD or DLBIdentify 2 primary care Documentation ofclinics for pilot social work outreachDevelop physician call/conferencetraining CDs Meet with advisoryHire social worker groupDesignate space forsocial workerOutcomes measuresdesignated
    •  Physician  Social Work  History  Stage dependent learning series  Medications ▪ Anticholinergic burden  Care management reduction  Day respite ▪ Sedative reduction  Area Agency on Aging  Targeted neuro exam referral  Objective Tests  Support group  Treatment  Behavior management ▪ Medical  Sleep guidelines ▪ Nonmedical  Meals on wheels  Reduce Vascular Risk  Referral for Financial  Driving Medical Assistant Planning Computerized cognitive test Computerized behavioral assessment Caregiver distress/burden
    •  Patient satisfaction Diagnoses Use of dementia medications Physician satisfaction
    •  Any health care  Training modules on CDs organization or practitioner to be shared with other with EMR can utilize this institutions new process  Organization must refine/adapt NIH toolbox with interpretative component  There is a guideline/template for primary care physicians  There is a social work template Alzheimer’s association chapters exist in all 50 states  All chapters can adopt the reimbursement model for their social workers
    •  Matching funds  Physicians are more  Siemens likely to adopt age  Microsoft specific screening when  Pfizer/Eisai testing is No cost to maintain  Standardized templates in Careplus  Interpreted once created/modified  Performed by a technician No proprietary costs to  Reimbursement utilize NIH toolbox commensurate with Alzheimer’s social complexity of visit workers can bill for services
    •  How the topic is framed/presented Where will testing take place Space for social worker Who will oversee testing Templates Patient/caregiver advisory council Outcomes Other