Assessing care of vulnerable elders--Alzheimer's disease: a pilot study of a practice redesign intervention to improve the quality of dementia care.
OBJECTIVE
To determine whether a practice redesign intervention coupled with referral to local Alzheimer's Association chapters can improve the quality of dementia care.


METHODS
Pre-post intervention.


METHODS
Two community-based physician practices.


METHODS
Five physicians in each practice and their patients aged 75 and older with dementia.


METHODS
Adaptation of the Assessing Care of Vulnerable Elders (ACOVE)-2 intervention (screening, efficient collection of clinical data, medical record prompts, patient education and empowerment materials, and physician decision support and education). In addition, physicians faxed referral forms to local Alzheimer's Association chapters, which assessed patients, provided counseling and education, and faxed information back to the physicians.


METHODS
Audits of pre- (5 per physician) and postintervention (10 per physician) medical records using ACOVE-3 quality indicators for dementia to measure the quality of care provided.


RESULTS
Based on 47 pre- and 90 postintervention audits, the percentage of quality indicators satisfied rose from 38% to 46%, with significant differences on quality indicators measuring the assessment of functional status (20% vs 51%), discussion of risks and benefits of antipsychotics (32% vs 100%), and counseling caregivers (2% vs 30%). Referral of patients to Alzheimer's Association chapters increased from 0% to 17%. Referred patients had higher quality scores (65% vs 41%) and better counseling about driving (50% vs 14%), caregiver counseling (100% vs 15%), and surrogate decision-maker specification (75% vs 44%). Some quality indicators related to cognitive assessment and examination did not improve.


CONCLUSIONS
This pilot study suggests that a practice-based intervention can increase referral to Alzheimer's Association chapters and improve quality of dementia care.
Reuben
David B
DB
Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Rand Corporation, Santa Monica, California, USA. Dreuben@mednet.ucla.edu
Roth
Carol P
CP
Frank
Janet C
JC
Hirsch
Susan H
SH
Katz
Diane
D
McCreath
Heather
H
Younger
Jon
J
Murawski
Marta
M
Edgerly
Elizabeth
E
Maher
Joanne
J
Maslow
Katie
K
Wenger
Neil S
NS
D000328:Adult; D000368:Aged; D000544:Alzheimer Disease / Q000628:therapy*; D002140:California; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008604:Mental Health Associations; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D014861:Washington