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A Technology-Driven Intervention to Improve Early Detection and Management of Cognitive Impairment

Award Number: R33AG069770
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/21/2020
PERIOD OF PERFORMANCE END DATE: 08/31/2026

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A Technology-Driven Intervention to Improve Early Detection and Management of Cognitive Impairment - Project Summary The prevalence of Alzheimer’s disease (AD) and AD-related dementias (ADRD) is expected to triple by 2050, contributing to decreased quality of life, increased medical care utilization, and additional burden on an already stressed primary care system. Many clinicians lack confidence to assess, diagnose and manage cognitive impairment (CI), and more than 50% of patients with CI are undiagnosed. Unfortunately, studies show that even in settings with high rates of standardized CI screening, very few patients who screen positive have documentation of any clinician follow-up action. To address these important problems, in phase 1 (R61) of this project, we will develop and validate a machine learning model (called MC-PLUS) using results from brief Mini- Cog (MC) screens completed routinely at Annual Medicare Wellness exams and electronic health record (EHR) data to identify patients at elevated risk of a future dementia diagnosis (AD/ADRD). We will also develop and validate a web-based and EHR-integrated CI clinical decision support (CI-CDS) system to engage patients and clinicians in conversation about elevated dementia risk, and to give clinicians the confidence and tools they need to diagnose and manage CI. Both MC-PLUS and the CI-CDS system will be added into an existing web-based CDS platform that has high use rates and primary care clinician satisfaction, and is already seamlessly integrated within the EHR. This CDS platform improves outcomes for patients with chronic diseases such as diabetes and high cardiovascular risk as shown in published studies. We will systematically validate the CI-CDS system with expert champions prior to conducting a pilot test at one primary care clinic. After milestones for success are demonstrated, we will begin phase 2 (R33), a large pragmatic trial with 30 primary care clinics randomized to receive CI-CDS or usual care (UC). We will evaluate change in clinician confidence in CI detection and care management in CI-CDS compared to UC clinics. If successful, the CI-CDS system will improve rates of new CI diagnosis and narrow existing sociodemographic disparities in adults with elevated dementia risk identified by MC-PLUS at index visit in CI-CDS compared to UC clinics. We will evaluate the impact of the intervention on care management and care plans using EHR data and chart audits. We will assess determinants of clinician actions in response to the CDS system using behavior change theory and technology acceptance constructs, and conduct phone surveys of patient and caregiver dyads to evaluate intervention effects on feelings of preparedness for decision making and distress. The CI-CDS system is immediately scalable to large numbers of patients through the existing non-commercialized CDS platform already in use for millions of patients in care systems spanning 14 states. The CDS system implemented as described could maximize return on massive investments that have been made in EHR systems, and provide a prototype to rapidly and consistently translate evolving evidence-based CI guidelines into personalized CI care and guidance within primary care.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	001	5	8/28/2025	NON-COMPETING CONTINUATION	$0
2025	2024	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	000	5	8/13/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $1,455,139 )
2024	2024	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	000	5	8/28/2024	NON-COMPETING CONTINUATION	$1,455,139
														Subtotal = $1,455,139

Issue Date FY: 2023 ( Subtotal = $1,389,806 )
2023	2023	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	004	4	8/25/2023	SUPPLEMENT FOR EXPANSION	$236,997
2023	2023	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	003	4	8/16/2023	NON-COMPETING CONTINUATION	$1,148,058
2023	2022	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	002	3	2/8/2023	EXTENSION WITH OR WITHOUT FUNDS	$0
2023	2022	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	001	3	12/5/2022	EXTENSION WITH OR WITHOUT FUNDS	$0
2023	2022	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	000	3	11/9/2022	EXTENSION WITH OR WITHOUT FUNDS	$4,751
														Subtotal = $1,389,806

Issue Date FY: 2022 ( Subtotal = $1,200,487 )
2022	2022	HEALTHPARTNERS INSTITUTE	8170 33RD AVE S	MINNEAPOLIS	MN	55425	HENNEPIN	USA	Aging Research	000	3	8/31/2022	EXTENSION WITH OR WITHOUT FUNDS	$1,200,487
														Subtotal = $1,200,487

Grand Total All Awards = $4,045,432

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A Technology-Driven Intervention to Improve Early Detection and Management of Cognitive Impairment

Award Number: R33AG069770

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/21/2020

PERIOD OF PERFORMANCE END DATE: 08/31/2026

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