Purpose: Receiving a diagnosis of dementia is only the beginning of how the disease will impact a patient and his/her support system. There are 5.5 million persons with dementia in the United States, and 81% of them live in the community.
Rationale: Clinicians seeing patients with home-based primary care programs are in a unique position to assess the medical and social effects of dementia on patients and support systems. Quality improvement metrics are implemented to document basic minimum standards but do not always translate into improved quality of care for patients.
Supporting literature: The 2019 Merit-based Incentive Payment System (MIPS) clinical quality measure for dementia requires documented safety concern screening in two domains of risk: 1) dangerousness to self or others and 2) environmental risks, as well as documentation of recommendations. No standardized safety screening tool exists for this measure.
Interventions: Two clinicians developed questions for a dementia safety screening tool (DSST) that was integrated into the charting system to ensure data was recorded in a reportable manner. The DSST records if a patient has 24-hour supervision, transfers independently, and has any of eight other risk factors such as fall risk, food insecurity, medication safety hazards, etc. After clinicians learned to use the DSST, a monthly report was generated to analyze use and flag patients for intervention. A workflow was developed for the practice’s registered nurse case managers (RNCM) and licensed clinical social workers (LCSW) to intervene for these at-risk patients.
Outcomes: Clinicians screened 85% of established patients with dementia in four months. One identified risk factor triggers an interprofessional coordination with standardized interventions via phone or house call based on risks identified.
Applicability to practice: The DSST is quick and easy to use, which increased buy-in from clinicians. Increasingly, clinicians are tasked to check a box in the patients’ electronic health records but doing so does not always improve patient care. The DSST is the first step of a standardized process in which high-risk patients receive interprofessional coordination, improving the quality of care for our homebound patients.