eCQ 11-3 Newsletter

Physicians Offered Framework, Tools for Improving Dementia Care for Patients and Caregivers

assessment tools for clinicians, but also relevant online resources addressing the needs of and support for caregivers. DEMENTIA CARE PLAN According to the authors, there are four core elements to a care plan for dementia: 1. Defining and acting on the cognitive problems encountered 2. Managing the neurological, mental, health, behavioral, and functional problems that result from the disease 3. Addressing relevant comorbid conditions 4. Providing caregiver assistance The article also includes a care plan checklist that physicians can use to address immediate threats, such as driving and home safety, as well as long-term issues, such as planning for advance directives, power of attorney, and hospice care. The authors recommend that the care plan be updated yearly, or as disease progression manifests. The downloadable, printable “Dementia Care Plan Checklist” is organized into the sections corresponding to the four core ele- ments. “It’s helpful to have a structured, systematic approach to developing care plans where all these factors are accounted for and revised as needed,” says co-author Natalia Loskutova, MD, PhD, director of evaluation for the American Academy of Family Physicians National Research Network. TIPS FOR PRACTICES How staff can contribute: Some elements on the care plan checklist can be delegated to members of the care team, who could conduct selected tests and surveys, suggest the authors. For instance, clinical staff can telephone family members before an office visit to ask about the patient’s function and cognition. With training, clinical staff could also help counsel patients/ caregivers and connect themwith community resources (such as support groups or financial or legal services) and provide them with educational handouts. Reimbursement: The authors remind family physicians that in 2018 Medicare introduced a billing code for “assessment of and care planning for a patient with cognitive impairment.” The article includes a list of required elements for using this CPT code 99483. “Rethinking what is important in caring for patients with de- mentia and using readily available clinical tools to address those issues allows physicians to render exceptional care not only to the millions of patients affected by these conditions, but also the millions more who care for them,” they conclude. Source: “Tools for Better Dementia Care,” Family Practice Management; January/February 2019; 26(1):11–16. Unwin BK, Loskutova N, Knicely P, Wood CD; Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American Academy of Family Physicians National Research Network, Leawood, Kansas; Carilion Clinic Center for Healthy Aging, Roanoke, Virginia.

Until advances in the diagnosis of and treatment options for dementia become available, family physicians can focus on what can be done to provide patient-centered care for dementia patients and their caregivers, according to a report published in Family Practice Management. The article offers clinicians guidance in creating a dementia care plan through a naviga- tional framework of quality measurements, clinical tools, and educational resources. “An old adage for the care of patients with dementia is to ‘provide safety and structure to the patient, sanity and serenity to the caregiver,’” write the authors. “Many issues of dementia care are out of anyone’s control, so it is important to plan for the known, common problems that develop with this condition.” Lacking a definitive diagnostic test and disease-modifying treatment, physicians may feel they should “stick with what they know” and treat only the dementia patient’s comorbid conditions, note the authors. “For the patients and their caregivers, however, it is dementia’s cognitive, functional, and behavioral losses that most affect their quality of life.” DEMENTIA QUALITY MEASURES The article presents the “Dementia Management QualityMea- surement Set” as a table listing titles and descriptions of nine nationally recognized, evidence-based metrics that can be used to evaluate the current quality of a patient’s care and to identify op- portunities for quality improvement. Quality measures include: • Disclosure of dementia diagnosis • Education and support of caregivers • Functional status assessment • Screening and management of behavioral and psychiatric symptoms • Safety concern screening and follow-up • Driving ability screening and follow-up • Advance care planning and palliative care counseling • Pain assessment and follow-up • Pharmacological treatment of dementia Once the quality of care has been evaluated, the authors sug- gest specific areas needing improvement then be targeted using such established processes as PDSA (Plan, Do, Study, Act). DEMENTIA PRACTICE TOOLS Corresponding to the nine categories of the measurement set is a list of “Dementia Practice Tools” containing the titles of several recommended evidence-based toolkits per domain of care, along with the website address for each. Many of these tools are scorable and can be incorporated into electronic health records, the authors note. Also included in some of these toolboxes are educational materials for caregivers. For example, the domain on pain as- sessment and follow-up contains not only practice guidelines and

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Volume 11, Issue 3