Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components

Abstract

BackgroundPrimary 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.MethodsWe 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.ResultsThe 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.ConclusionWe 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.

Towards Consensus on Essential Components of Physical Examination in Primary Care-based Memory Clinics*

“…( 26 , 27 , 29 ) We have previously shown that close integration of specialists within PCMCs can serve as a means to increase capacity, and this could apply to training related to a standardized physical examination. ( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”

“…( 22 , 30 ) Furthermore, the lack of agreement among respondents regarding which providers are best suited for specific assessment components mirrors our previous results regarding the integration of PCMCs within the broader health system, and the related need for clarity on mutually understood roles among all clinicians across the system. ( 22 )…”

“…In the resource-constrained primary care context, it is important to identify which, if any, physical examination maneuvers are required to inform the differential diagnosis or management decisions such as referral to a specialist for further assessment. ( 21 ) In the context of a larger study to obtain consensus among PCMC clinicians and specialists on a Quality Assurance framework for dementia care, ( 22 ) we sought to identify which physical examination maneuvers are essential to ADRD diagnosis and management. We also explored perceptions about which clinicians are best suited to perform specific components of the physical examination.…”

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

“…There is, however, significant existing evidence that high-volume PCPs achieve their high volume through briefer appointments [9][10][11]. Our use of health administrative data limited the scope of primary care quality indicators for people with dementia we could assess; the relation of high-volume care and quality indicators such as patient or caregiver satisfaction, frequent reassessment of cognitive status and provision of caregiver support [20,48,49] should be studied in subsequent work. Also, our measure of influenza vaccination has only moderate sensitivity and specificity.…”

Last Issue, 2016

“…Hategan et al (2) examine the associations between emergency department use and homelessness in the geriatric population. Clinical gaps in the in-patient care of geriatric in-patients with heart failure, as perceived by the patient’s caregivers, are systematically examined by Azad et al (3) A careful methodological examination of the Team Standardized Assessment of Clinical Encounter Report (Team StACER) is performed by Dr. Camilla Wong et al ., (4) and Heckman et al (5) examine the key quality assurance components involved in providing good community dementia care.…”