1. Henry Ford Health System
Dementia Screening for Senior Patients

2. Picker Awards
“Understanding and respecting
patients’ values, preferences,  Picker awards established in 2003
and expressed needs is the
foundation of patient-centered  Independent nonprofit
care”
Harvey Picker  Patient-centered care
Founder
1915-2008  Improvement of patient’s experience
and interaction with health care
providers
 Picker Surveys are the world
standard for measuring
performance “through the patient’s
eyes”

3.  World Health Organization If the costs of
AD were a
 Significant threat to health of all nations
world economy,
 First chronic disease to be cited
it would rank as
 Dementia as Chronic Disease
the 13th largest
 Genetic vulnerability & environmental exposure
 Importance of risk factor modification
▪ Disease modification
 National Alzheimer’s Association
 Pre-dementia states
▪ Mild Cognitive impairment
▪ Pre-clinical AD AD
 Earliest stages are target of treatment
 National Alzheimer’s Project Grant
 Medicare Wellness Visit
 Patients must be asked about cognition at an annual visit

4.  Dispel the mythology of memory loss with aging
 “Normal” age related cognitive decline is not normal
 Make the Diagnosis
 Alzheimer’s Disease?
 Lewy Body Disease?
 Frontal Dementia?
 Care vs Cure
 Disease modification strategies
 Family as patient
 Community Alliances

5.  Current norms
 New treatments target
outdated
preclinical states
 MCI
 Biomarkers and risk
 Preclinical changes
factor identification
 Neuropsych tests
 Serial testing (within
change late in course subjects) more powerful
 NP testing normal in to predict pathology
brains with AD changes ▪ Need office easy to administer
office based tool
 Normal NP test does not ▪ Repeat regularly as part of health
mean brain is normal maintenance
 Second to last
biomarker to change

6.  Lack of time for
assessment
 Uncertainty regarding
diagnostics
 Complexity of cognitive
testing
 Lack of resources for
management of behavioral
and social issues,
community resources,
caregiver training Henry Ford Hospital

7.  Routine dementia screening
annually, starting at age 70
 Internet tools for cognitive
and behavioral assessments
 Identify a specific dementia
syndrome
 Provide appropriate medical
and non-medical treatments
 Align patient and caregiver
with network of community
supports

8. NIH Toolbox
NeuroQual
Public domain web-based
assessments
Computerized
30 minutes
Scoring and interpretation
Oversight by support
personnel
Identifies MCI, AD, non-AD Behavior assessment
Caregiver distress

9. Accessed through CarePlus
Guides diagnostic history, physical exam, tests, and treatment
Identifies red flags for referral
Direct link on CarePlus for Neurology referral if needed

10. Education
Grosfeld
Behavior
Collaborative
management
Community referrals
All are referred
Direct link on careplus
Located at HFH

11. June 1-Sept 30 Oct 1-Nov 30 Dec 1-Feb 28 Mar 1-May 31
Development Training Pilot Evaluation
Refine web based tools Physician  Every patient >/= 70 Computerized screen
Interpretive component Support personnel screened in 2 clinics for patients >/=70
Designate space in Social workers Database collection Screening labs
each clinic for testing Meet with advisory Meet with advisory MRI (or CT) brain
Purchase computers group group Specific diagnosis
IT issues Cholinesterase inhibitor
Patient advisory group for AD or DLB
Identify 2 primary care Documentation of
clinics for pilot social work outreach
Develop physician call/conference
training CDs Meet with advisory
Hire social worker group
Designate space for
social worker
Outcomes measures
designated

12.  Physician  Social Work
 History  Stage dependent learning
series
 Medications
▪ Anticholinergic burden  Care management
reduction  Day respite
▪ Sedative reduction  Area Agency on Aging
 Targeted neuro exam referral
 Objective Tests  Support group
 Treatment  Behavior management
▪ Medical
 Sleep guidelines
▪ Nonmedical
 Meals on wheels
 Reduce Vascular Risk
 Referral for Financial
 Driving
Medical Assistant Planning
Computerized cognitive test
Computerized behavioral assessment
Caregiver distress/burden

13.  Patient satisfaction
 Diagnoses
 Use of dementia medications
 Physician satisfaction

14.  Any health care  Training modules on CDs
organization or practitioner to be shared with other
with EMR can utilize this institutions
new process
 Organization must
refine/adapt NIH toolbox with
interpretative component
 There is a guideline/template
for primary care physicians
 There is a social work template
 Alzheimer’s association
chapters exist in all 50
states
 All chapters can adopt the
reimbursement model for their
social workers

15.  Matching funds  Physicians are more
 Siemens likely to adopt age
 Microsoft specific screening when
 Pfizer/Eisai testing is
 No cost to maintain  Standardized
templates in Careplus  Interpreted
once created/modified  Performed by a technician
 No proprietary costs to  Reimbursement
utilize NIH toolbox commensurate with
 Alzheimer’s social complexity of visit
workers can bill for
services

16.  How the topic is framed/presented
 Where will testing take place
 Space for social worker
 Who will oversee testing
 Templates
 Patient/caregiver advisory council
 Outcomes
 Other