Abstract:
BACKGROUND:Early detection of cognitive impairment is a goal of high-quality geriatric medical care, but new approaches are needed to reduce rates of missed cases. OBJECTIVE:To evaluate whether adding routine cognitive screening to primary care visits for older adults increases rates of dementia diagnosis, specialist referral, or prescribing of antidementia medications. SETTING:Four primary care clinics in a university-affiliated primary care network. DESIGN:A quality improvement screening project and quasiexperimental comparison of 2 intervention clinics and 2 control clinics. The Mini-Cog was administered by medical assistants to intervention clinic patients aged 65+ years. Rates of dementia diagnoses, referrals, and medication prescribing were tracked over time using computerized administrative data. RESULTS:Twenty-six medical assistants successfully screened 70% (n = 524) of all eligible patients who made at least 1 clinic visit during the intervention period; 18% screened positive. There were no complaints about workflow interruption. Relative to baseline rates and control clinics, Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive enhancing medications. Patients without previous dementia indicators who had a positive Mini-Cog were more likely than all other patients to receive a new dementia diagnosis, specialty referral, or cognitive enhancing medication. However, relevant physician action occurred in only 17% of screen-positive patients. Responses were most related to the lowest Mini-Cog score level (0/5) and advanced age. CONCLUSION:Mini-Cog screening by office staff is feasible in primary care practice and has measurable effects on physician behavior. However, new physician action relevant to dementia was likely to occur only when impairment was severe, and additional efforts are needed to help primary care physicians follow up appropriately on information suggesting cognitive impairment in older patients.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Borson S,Scanlan J,Hummel J,Gibbs K,Lessig M,Zuhr Edoi
10.1007/s11606-007-0202-8subject
Has Abstractpub_date
2007-06-01 00:00:00pages
811-7issue
6eissn
0884-8734issn
1525-1497journal_volume
22pub_type
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
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abstract:BACKGROUND:Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective. OBJECTIVE:Evaluate whether a PN program for refugee women decreases disparities in brea...
journal_title:Journal of general internal medicine
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pub_type: 杂志文章,多中心研究
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journal_title:Journal of general internal medicine
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journal_title:Journal of general internal medicine
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更新日期:2007-12-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:2006-03-01 00:00:00
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doi:10.1007/s11606-010-1542-3
更新日期:2011-04-01 00:00:00
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更新日期:2016-10-01 00:00:00
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更新日期:2010-12-01 00:00:00
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更新日期:2008-01-01 00:00:00
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journal_title:Journal of general internal medicine
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更新日期:1993-12-01 00:00:00
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更新日期:2010-10-01 00:00:00
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