Bowers says Lee Memorial is on the road to viewing dementia as a population health initiative. Part of working toward PCMH status means having a robust electronic medical record, which Bowers says is in place and helps coordinate all the moving parts a dementia patient often requires. She says the system already has patient registries for asthma, diabetes, and obesity; dementia is in the future.
"We should be able to build registries of our patients with dementia and then as to where they are in their dementia issue," says Bowers. "Then we'll be able to reach out and be more proactive. We're in that phase of population health in developing registries elsewhere, but we can and will be bringing that into the memory care program, hopefully within the next year."
Success key No. 3: Establish clinical practice guidelines
Team-based, interdisciplinary care for dementia patients is not a common practice nationwide. Large health systems and academic medical centers often are better able to bear the burden of low reimbursements from Medicare and to employ fellowship-trained and board-certified geriatricians who may serve in multiple roles, such as provider, researcher, or educator.
Kyle Allen, DO—vice president for clinical integration and medical director for geriatric medicine and the lifelong health division for Riverside Health System, a nonprofit system based in Newport News, Virginia, that includes seven hospitals, a medical group, and a full continuum of care for aging patients—says a patchwork of grants and philanthropy help pay for care of patients with dementia, but it's not enough.
"Geriatric assessment and team management of this illness is evidenced-based and effective," he says. "Medicare does not pay for it. So we can only do so many of these assessments because we can only afford so much of it."
Allen is also part of the administrative team for Riverside Health's Center for Excellence in Aging and Lifelong Health, which looks for and implements programs to help the aging population. He says that approval of a grant request to the Patient-Centered Outcomes Research Institute (an independent nonprofit organization authorized by Congress in 2010) holds what he believes is the most promise for patients with dementia. The grant would fund an initiative to standardize clinical practice guidelines in primary care offices.
Allen says established protocols for evaluation, screening, treatment, and care planning would fill the existing gaps in care and lessen the overwhelming nature that a dementia diagnosis presents to the family members of the patient.
"We have mapped out the workflow of how to do this," says Allen, who also describes the care coordination of dementia patients as a reengineering of the doctor's office. "We started putting together a task force in 2011, and the missing piece was the integration of physicians. And that's where people go."
Allen says PCPs may feel they don't have the resources to address dementia, and in some cases, early warning signs may even go unnoticed. Using guidelines will help the practice staff and physicians understand how to recognize patients who may need to be screened for dementia and what to do with patients who have it.