One year ago, our ACO in Action story reported on preparations to pilot a dementia early detection program at Southern Maine Health Care primary care practices in Sanford. Today, we’re pleased to provide an update.
Barbara Steele is a MaineHealth ACO nurse care manager who noticed a problem. Working at Southern Maine Health Care’s family medicine and internal medicine practices in Sanford, she was receiving numerous referrals for elderly patients coming in with undiagnosed moderate and severe dementia.
“We were behind the ball in trying to help these patients,” says Barbara, “so I went to each provider and asked what our process was for detecting memory loss and following up with it.” She discovered that “there was no path to early detection.”
In response to her findings, Barbara teamed up with Michelle Nevers from MaineHealth Healthy Aging to establish a pilot project at the two Sanford practices to detect dementia in the early stages, educate patients and families about the disease and connect them to resources that provide support and enable them to plan for future care needs. The pilot launched in October, 2017.
“We decided to make it very simple,” says Barbara. “When a patient 65 years or older comes in for a Medicare Annual Wellness Visit, we screen them for memory loss using the screening question, ‘have you noticed any changes in your memory recently’ and the quick Mini-Cog cognitive impairment assessment tool. Based on the results, the provider will make a decision whether or not to bring them back for further testing using the more comprehensive Montreal Cognitive Assessment (MoCA). After that, if indicated, PCP-based management of any cognitive impairment would commence or a referral would be made to a specialist. Patients and families would also get connected to community resources.
Results from the first nine months of the pilot (October, 2017 – June, 2018) have been very encouraging. The goal for the first full year is to screen 75% of the practices’ age-appropriate patients using the Mini-Cog. Data shows that the goal has already been exceeded. 357 patients have completed the Mini-Cog since October, 83% of those eligible. 30 patients have completed the MoCA. 16 patients were offered a referral and eight completed the referral process to a specialist and/or community resources.
Providers and clinical staff participating in the pilot are finding that the assessment process has integrated well into Medicare Annual Wellness Visits. At a recent meeting to review results, Medical Assistant Christine Bruno noted that “the work process is going well -- it’s part of the flow now.”
Dr. Shirley Frederick added that she finds “the whole process enjoyable,” noting that “it doesn’t take a tremendous amount of time and is very valuable to patients.”
The larger outcome of the pilot so far is hard to quantify. However, qualitative signs hint at a possible impact. The Alzheimer’s Association reports an increase in referrals from the participating practices’ service area and the practices themselves report fewer crisis calls since the pilot began.
The pilot will continue through October, 2018 and will soon incorporate feedback from patients.
It’s too early to speculate about the possible spread of the early detection protocol. However, the addition this year of CPT code 99483 for cognitive impairment care planning services may support broader adoption.
To learn more about the pilot and early detection of dementia, please email Barbara Steele.