RF1AG100511

IMPLEMENTING SCALABLE TOOLS IN PRIMARY CARE FOR EARLY ALZHEIMER’S DISEASE DETECTION ACROSS A HEALTH SYSTEM - PROJECT SUMMARY / ABSTRACT ALZHEIMER’S DISEASE AND RELATED DEMENTIAS (ADRD) AFFECT NEARLY 7 MILLION OLDER AMERICANS, PROJECTED TO NEARLY DOUBLE BY 2050. EARLY, ACCURATE DIAGNOSIS HAS BECOME INCREASINGLY IMPORTANT WITH ADVANCES IN DISEASE- MODIFYING THERAPIES MOST EFFECTIVE AT INITIAL DISEASE STAGES. HOWEVER, SHORTAGES OF SPECIALISTS LEAD TO DELAYED DIAGNOSES AND MISSED THERAPEUTIC OPPORTUNITIES. ADDRESSING THIS CHALLENGE REQUIRES SCALABLE STRATEGIES TO EQUIP PRIMARY CARE PROVIDERS (PCPS) WITH EFFECTIVE TOOLS FOR TIMELY ADRD DIAGNOSIS AND CARE. WE WILL IMPLEMENT AND RIGOROUSLY EVALUATE THE BRAIN HEALTH CARE ACCELERATOR (BHCA), A COMPREHENSIVE CLINICAL AND SYSTEMS INTERVENTION DESIGNED TO TRANSFORM DEMENTIA CARE IN PRIMARY CARE. BHCA INTEGRATES STRUCTURED COGNITIVE ASSESSMENTS, BLOOD BIOMARKERS (I.E., PLASMA P-TAU217), EHR-EMBEDDED DECISION SUPPORT TOOLS, AND MULTIDISCIPLINARY SPECIALTY CO-MANAGEMENT CLINICS, SUPPORTED BY STRUCTURED PCP TRAINING, CLINICAL CHAMPIONS, AND WORKFLOW AND FINANCIAL INCENTIVES. USING A PRAGMATIC STEPPED-WEDGE TRIAL DESIGN, WE WILL EVALUATE BHCA ACROSS 15 DIVERSE PRIMARY CARE CLINICS (~120 PCPS) WITHIN THE UNIVERSITY OF KANSAS HEALTH SYSTEM (UKHS). WE WILL EVALUATE BHCA’S CLINICAL EFFECTIVENESS AND IMPLEMENTATION OUTCOMES USING THE ESTABLISHED RE-AIM FRAMEWORK (REACH, EFFECTIVENESS, ADOPTION, IMPLEMENTATION, MAINTENANCE) AROUND THREE SPECIFIC AIMS: • AIM 1 (EFFECTIVENESS): EVALUATE THE EFFECT OF BHCA ON INCREASING OVERALL ADRD DIAGNOSIS RATES IN PRIMARY CARE AND SHIFTING IDENTIFICATION TO EARLIER COGNITIVE STAGES, WITH SECONDARY OUTCOMES ASSESSING DIAGNOSTIC ACCURACY (VIA EXPERT ADJUDICATION) AND APPROPRIATE BIOMARKER USAGE (EHR AUDIT) TO ENSURE HIGH-QUALITY DIAGNOSES. • AIM 2 (REACH, ADOPTION, IMPLEMENTATION): ASSESS PCP ADOPTION AND IMPLEMENTATION OF BHCA TOOLS, HYPOTHESIZING INCREASED PCP DIAGNOSTIC CONFIDENCE, SUSTAINED ADOPTION OF STRUCTURED COGNITIVE ASSESSMENTS, ENHANCED BIOMARKER UTILIZATION, INCREASED COGNITIVE CARE BILLING (CMS CODE 99483), AND IMPROVED REFERRAL PATTERNS TO SPECIALIZED DEMENTIA SERVICES. • AIM 3 (IMPLEMENTATION AND MAINTENANCE): IDENTIFY CONTEXTUAL BARRIERS AND FACILITATORS INFLUENCING SUSTAINED BHCA USE IN PRIMARY CARE, SPECIFICALLY EVALUATING FEASIBILITY, ACCEPTABILITY, AND APPROPRIATENESS OF THE INTERVENTION THROUGH PCP SURVEYS AND QUALITATIVE INTERVIEWS GUIDED BY THE CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH (CFIR). THE BHCA REPRESENTS A SCALABLE, EHR-INTEGRATED CLINICAL INTERVENTION DESIGNED TO EMPOWER PCPS TO DIAGNOSE AD EARLIER AND MORE ACCURATELY, SHIFTING DEMENTIA CARE FROM SPECIALTY-DEPENDENT TO PRIMARY CARE–LED. SUCCESSFUL IMPLEMENTATION OF THE BHCA INTERVENTION COULD SERVE AS A NATIONAL MODEL, SIGNIFICANTLY REDUCING DIAGNOSTIC DELAYS AND IMPROVING DEMENTIA CARE COORDINATION ACROSS DIVERSE PRIMARY CARE SETTINGS.

University Of Kansas Medical Center Research Institute

<P>TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE.</P>

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Kansas City, Kansas 66160 United States

Single Zip Code

Research on Current Topics in Alzheimer's Disease and Its Related Dementias (R01 Clinical Trial Optional) (PAR-25-332)