Stakeholder-informed pragmatic trial protocol of the TabCAT-BHA for the detection of cognitive impairment in primary care.
Cognitive impairment
Dementia
Detection
Digital cognitive assessments
Primary care
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
06 Aug 2024
06 Aug 2024
Historique:
received:
07
06
2024
accepted:
25
07
2024
medline:
7
8
2024
pubmed:
7
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia. This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity. We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027. Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention's effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system. Clinicaltrials.gov: NCT06090578 (registered 10/24/23).
Sections du résumé
BACKGROUND
BACKGROUND
Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia.
METHODS
METHODS
This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns (n ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity.
RESULTS
RESULTS
We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027.
CONCLUSIONS
CONCLUSIONS
Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention's effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system.
TRIAL REGISTATION
BACKGROUND
Clinicaltrials.gov: NCT06090578 (registered 10/24/23).
Identifiants
pubmed: 39107706
doi: 10.1186/s12875-024-02544-9
pii: 10.1186/s12875-024-02544-9
doi:
Banques de données
ClinicalTrials.gov
['NCT06090578']
Types de publication
Journal Article
Clinical Trial Protocol
Langues
eng
Sous-ensembles de citation
IM
Pagination
286Subventions
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Organisme : NINDS NIH HHS
ID : U01NS128913
Pays : United States
Informations de copyright
© 2024. The Author(s).
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