title: Assessing care of vulnerable elders--Alzheimer's disease: a pilot study of a practice redesign intervention to improve the quality of dementia care.
abstract: 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.
authors.affiliation: 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
authors.forename: David B
authors.initials: DB
authors.lastname: Reuben
authors.forename: Carol P
authors.initials: CP
authors.lastname: Roth
authors.forename: Janet C
authors.initials: JC
authors.lastname: Frank
authors.forename: Susan H
authors.initials: SH
authors.lastname: Hirsch
authors.forename: Diane
authors.initials: D
authors.lastname: Katz
authors.forename: Heather
authors.initials: H
authors.lastname: McCreath
authors.forename: Jon
authors.initials: J
authors.lastname: Younger
authors.forename: Marta
authors.initials: M
authors.lastname: Murawski
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Edgerly
authors.forename: Joanne
authors.initials: J
authors.lastname: Maher
authors.forename: Katie
authors.initials: K
authors.lastname: Maslow
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: 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