Interventions to improve quality of care: the Kaiser Permanente-alzheimer's Association Dementia Care Project.
OBJECTIVE
To improve quality of dementia care in a Kaiser Permanente service area through rigorous dissemination of practice guidelines and social worker support for physicians and patients.


METHODS
Pre-post design with practice behavior change assessed by medical record review, and provider and caregiver satisfaction with care assessed by surveys.


METHODS
A diagnostic guideline and later a management guideline were adopted for use by Kaiser Permanente physicians in metropolitan Los Angeles. Physicians received training based on the guidelines, and social workers provided ancillary support. Eighty-three community-dwelling dementia patients and their caregivers were referred to the project by primary care physicians and then were assessed and followed by social workers. Data were abstracted from medical records to determine whether these interventions led to improved quality of care as indicated by adherence to key care processes derived from the adopted dementia guidelines. Chi-square and t tests were applied to compare guideline adherence and satisfaction rates before and after the interventions.


RESULTS
Compared with baseline, higher rates of provider and caregiver satisfaction with Kaiser's system of dementia care were found at the postintervention follow-up. There also were significantly higher rates of adherence to several practice guideline-based quality measures: assessment of cognitive status; referrals to the Alzheimer's Association; and assessments of activities of daily living, decision-making capacity, depression, and wandering risk.


CONCLUSIONS
Quality of primary care for people with dementia can be improved through guideline implementation with care management support by social workers.
Cherry
Debra L
DL
Alzheimer's Association of Los Angeles, CA 90036, USA. debra.cherry@alz.org
Vickrey
Barbara G
BG
Schwankovsky
Lenore
L
Heck
Elizabeth
E
Plauchm
Michelle
M
Yep
Ralph
R
D000544:Alzheimer Disease / Q000451:nursing / Q000628:therapy*; D017028:Caregivers; D006302:Health Services Research; D006801:Humans; D015141:Los Angeles; D008329:Managed Care Programs / Q000592:standards*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*