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Multidisciplinary Guidelines for Quality Care in Dementia

Guideline Watch |
November 26, 2013

Multidisciplinary Guidelines for Quality Care in Dementia

  1. Brandy R. Matthews, MD

A newly devised list of 10 measures is aimed at improving outcomes for dementia patients and caregivers.

  1. Brandy R. Matthews, MD

Sponsoring Organizations: American Academy of Neurology, American Geriatrics Society, American Psychiatric Association, American Medical Directors Association, and the American Medical Association's Physician Consortium of Performance Improvement

Target Population: Practitioners involved in the care of patients with dementia

Background and Objective: To determine quality measurements that improve the care of patients with dementia

Key Points

This set of 10 quality measures for dementia care is intended for development and assessment of care for patients with an established dementia diagnosis following appropriate investigations. The measures do not identify specific clinical syndromes or predicted neuropathology.

  • The measures include annual assessment of dementia stage, cognition, function, and neuropsychiatric symptoms, including an added measure of depressive symptoms. Additionally, counseling regarding safety, driving, palliative and advanced care, and caregiver issues are identified as areas of focus. The only measure directly related to medical management pertains to neuropsychiatric symptoms. The full measures are available at http://viajwat.ch/1b8z490.

  • The guidelines highlight the need for consistent, longitudinal assessments and interventions for both patients and caregivers dealing with dementia diagnoses.

  • The authors note that each of the measures, with the exception of palliative care counseling and advanced care planning, has been identified as a source of possible incentive payments to eligible healthcare professionals and that annual cognitive assessment is a clinical quality measure included in the electronic health record Meaningful Use incentive program, supervised by the Centers for Medicare and Medicaid Services.

Comment

Undoubtedly, these guidelines will improve the consistency with which dementia care is administered across providers and demographics. Unfortunately, a purely algorithmic approach fails to account for the highly variable pathologies that result in dementia. Binding physician reimbursement to such measures may result in an increase in clinically irrelevant documentation and loss of subspecialty physician time to attend to the individualized needs of patients and families.

  • Disclosures for Brandy R. Matthews, MD at time of publication Grant / research support National Institute on Aging

Citation(s):

Reader Comments (2)

Kathy Shuler Other Healthcare Professional, Geriatrics, Professional Pharmacy

This article is a great reminder of the multitude of problems association with dementia patients. You commented on the coming problems of MD reimbursement in monitoring theses patients. This is a great place for a clinical pharmacist to do the monitoring and then report the info to the MD.

SHELDON BALL Physician, Geriatrics, Anvita Health

The comment touches on the pitfalls of using surrogate markers to measure quality. Why not consider such markers as mortality, hospitalization, emergency department visits, patient and caregiver satisfaction, and costs for binding physician reimbursement and assess the impact? Just a thought.

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