title: Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components.
abstract: BACKGROUND
  Primary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer's disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs.
  
  
  METHODS
  We employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. Thirty-eight candidate QIs and 19 potential quality improvement mechanisms were presented to participants in two rounds of electronic Delphi surveys. Written comments were collected and descriptively analyzed.
  
  
  RESULTS
  The response rate for the first and second rounds were 21.3% (n = 179) and 12.8% (n = 88), respectively. The majority of respondents were physicians. Fourteen QIs remained after the consensus process. Ten quality improvement mechanisms were selected with those characterized by specialist integration, such as case discussions and mentorships, being ranked highly. Written comments revealed three major themes related to potential barriers and facilitators to quality assurance: 1) perceived importance, 2) collaboration and role clarity, and 3) implementation process.
  
  
  CONCLUSIONS
  We successfully utilized a consultative process among primary and specialty providers to identify core QIs and quality improvement mechanisms for PCMCs. Identified quality improvement mechanisms highlight desire for multi-modal education. System integration and closer integration between PCMCs and specialists were emphasized as essential for the provision of high-quality dementia care in community settings.
authors.affiliation: Schlegel - University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.affiliation: Schlegel - University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; Conestoga College's School of Health & Life Sciences and Community Services, Schlegel Villages, Kitchener, ON, Canada.
authors.forename: Veronique M
authors.initials: VM
authors.lastname: Boscart
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Franco
authors.affiliation: Specialized Geriatric Services, St. Joseph's Health Care London, London, ON, Canada; Parkwood Institute, London, ON, Canada.
authors.forename: Loretta
authors.initials: L
authors.lastname: Hillier
authors.affiliation: University of Western Ontario, London, ON, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Crutchlow
authors.affiliation: Schlegel - University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada; Department of Family Medicine, McMaster University, Kitchener, ON, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Lee
authors.affiliation: University of Ottawa, Ottawa, ON, Canada; Division of Geriatric Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyere Research Institute, Ottawa, ON, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Molnar
authors.affiliation: Department of Psychiatry, Queen's University, Kingston, ON, Canada.
authors.forename: Dallas
authors.initials: D
authors.lastname: Seitz
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
keywords: chronic disease management; dementia; primary care; quality improvement; quality indicators; system integration