Quality improvement in neurology: Dementia management quality measures.

Center for Innovative Care in Aging (L.N.G.), Community Public Health, School of Nursing and Department of Psychiatry, Division of Geriatrics and Gerontology, Johns Hopkins University, School of Medicine, Baltimore, MD
Neurology (Impact Factor: 8.3). 09/2013; DOI: 10.1212/WNL.0b013e3182a956bf
Source: PubMed

ABSTRACT Professional and advocacy organizations have long urged that dementia be recognized and properly diagnosed.(1,2) With the passage of the National Alzheimer's Project Act(3) in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer disease and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings.(4) Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE)(5), implementation has not been widely embraced by practitioners, health care systems, or insurers. In this Executive Summary (full manuscript on, we report on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of patients with dementia. This effort was led by the American Academy of Neurology, the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement (PCPI). Both the ACOVE measures and the measurement set described here apply to patients whose dementia has already been identified and properly diagnosed. Though similar in concept to ACOVE, the DWG measurement set differs in several important ways: it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care prior to the advanced stages of illness, and provides evidence-based support for its recommendations and guidance on the selection of instruments useful in tracking patient-centered outcomes. In addition, the DWG measurement set specifies annual reassessment and updating of interventions and care plans for dementia-related problems that affect families and other caregivers as well as patients. Here, we first provide a brief synopsis of why major reforms in health care design and delivery are needed in order to achieve substantive improvements in the quality of care, and then list the final measures approved for publication, dissemination, and implementation.

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