New Dementia Quality Measures Issued by 5 Professional Organizations

Calling on payers to use quality as a basis for reimbursement
VBCN - April 2014 Volume 1, No 1

An interdisciplinary group of 5 professional organizations, the Dementia Measures Work Group (DWG), recently published a set of quality measures that could improve the care of patients with dementia (Odenheimer G, et al. Neurology. 2013;81:1545-1549).

The 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.

“The idea was to establish the absolute minimum standard of good quality care that could be easily performed and measured,” said lead investigator Germaine L. Odenheimer, MD, Associate Professor, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma College of Medicine, Oklahoma City.

Dr Odenheimer and colleagues acknowledged that other efforts have been made to set dementia quality care standards; however, these have not been fully embraced by providers, healthcare systems, or by health insurers.

The new set of quality measurements incorporates some of the concepts previously put forth, but expands on them. This new set of measures:

  • Includes all stages of dementia in a single measurement set
  • Calls for the use of functional staging in planning care
  • Prompts the use of validated in­struments in patient and caregiver assessment and in patient interventions
  • Highlights the relevance of using palliative care concepts
  • Recommends instruments for tracking patient-centered outcomes.

“For those of us who specialize in dementia care, these measures seemed so obvious, but they are not being met by the medical community. We hope that as insurers base payment on quality measures, that these will become routine and standard of care,” Dr Odenheimer said in an interview with Value-Based Care in Neurology.

Dr Odenheimer and colleagues emphasize that there are many opportunities for improvement in the area of dementia care and its assessment, based on the following considerations:

  • Healthcare for persons with dementia is inconsistent, often suboptimal, and largely unplanned
  • Ethnic and socioeconomic disparities are important influences on the quality of dementia care
  • Partnership with caregivers is integral to improving care
  • The well-being and behavioral stability of patients with dementia is strongly influenced by the well-being of their caregivers
  • Comprehensive integrated care and quality improvement initiatives must be explicit and practical.

What Quality Measures Are Appropriate in Dementia Management?
Clinical performance measures ideally include patient-level outcomes, as well as processes of care, but because of the nature of this disease, patient-­reported measures are often unreliable. In their place, the assessment of dementia care must rely on measuring care processes that have been associated with positive outcomes in a rapidly evolving evidence base, the investigators indicated.

Dr Odenheimer and colleagues constructed the following measurement set of auditable quality measures that can be applied to the care of patients already diagnosed with dementia.

It asks healthcare providers to determine the percentage of patients, regardless of age (and in some cases, caregivers), who underwent the following care modalities within a 12-month period:

  • Staging of dementia as mild, moderate, or severe
  • Cognitive, functional, and neuropsychiatric symptom assessments
  • Management of neuropsychiatric symptoms, if present, or recommendation for such
  • Screening for depressive symptoms
  • Counseling regarding safety concerns and risks of driving
  • Palliative care counseling and advance care planning
  • Caregiver education and support, including referral to additional resources.

Practical Implications
“The DWG measures have the potential to dramatically affect practice and improve the quality of care provided to patients with dementia,” Dr Odenheimer and colleagues predicted.

They noted that almost all measures were selected for the most recent Physician Quality Reporting System lists, and 1 measure (cognitive assessment) was included in the clinical quality measure list for the Centers for Medicare & Medicaid Services’ meaningful use.

“The emphasis on dementia management in this measurement set recognizes the enormous challenge dementia presents to individual patients and their caregivers, health care providers, public health, and government and private insurers,” Dr Odenheimer and colleagues suggested. “While patients, caregivers, and health professionals await more effective disease-modifying treatments for patients with dementia, adherence to the measures outlined here will improve the quality of life for patients and caregivers with dementing illnesses.”

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