Advisory Council January 2015 Meeting Presentation: Clinical Services Update

01/26/2015

ADVISORY COUNCIL ON ALZHEIMER'S RESEARCH, CARE, AND SERVICES

Monday, January 26, 2015

Washington, D.C.

 

Clinical Services Update

Shari M. Ling, MD
Centers for Medicare & Medicaid Services
Center for Clinical Standards and Quality

Health Resources and Services Administration

  • New Geriatrics Workforce Enhancement Funding Opportunity Released
  • Deadline – March 5, 2015
  • $4 Million for Alzheimer’s disease and related dementia (ADRD) education and training
  • Working on Unified Alzheimer’s Disease Curriculum
  • In process of aggregating data from GEC ADRD education and training

 

Screen Shot of the cover of The Gerontological Society of America Workgroup on Cognitive Imapirment Detection and Earlier Diagnosis: Report and Recommendations.
www.geron.org

Physician Quality Reporting System Dementia Measures Groups Measures

NQF# & Title Measure Description
280 – Dementia: Staging of Dementia Percentage of patients, regardless of age, with a diagnosis of dementia whose severity of dementia was classified as mild, moderate or severe at least once within a 12 month period
281 - Dementia: Cognitive Assessment Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least within a 12 month period
282 - Dementia: Functional Status Assessment Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of functional status is performed and the results reviewed at least once within a 12 month period
283 - Dementia: Neuropsychiatric Symptom Assessment Percentage of patients, regardless of age, with a diagnosis of dementia and for whom an assessment of neuropsychiatric symptoms is performed and results reviewed at least once in a 12 month period
284 - Dementia: Management of Neuropsychiatric Symptoms Percentage of patients, regardless of age, with a diagnosis of dementia who have one or more neuropsychiatric symptoms who received or were recommended to receive an intervention for neuropsychiatric symptoms within a 12 month period
285 - Dementia: Screening for Depressive Symptoms Percentage of patients, regardless of age, with a diagnosis of dementia who were screened for depressive symptoms within a 12 month period
286 – Dementia: Counseling Regarding Safety Concerns Percentage of patients, regardless of age, with a diagnosis of dementia or their caregiver(s) who were counseled or referred for counseling regarding safety concerns within in a 12 month period
287 - Dementia: Counseling Regarding Risks of Driving Percentage of patients, regardless of age, with a diagnosis of dementia or their caregiver(s) who were counseled regarding the risks of driving and the alternatives to driving at least once within a 12 month period
288 - Dementia: Caregiver Education and Support Percentage of patients, regardless of age, with a diagnosis of dementia whose caregiver(s) were provided with education on dementia disease management and health behavior changes AND referred to additional resources for support within a 12 month period

Highest Priority for Future Measure Development

NQF Final Report on Priority Setting for Healthcare Performance Measurement Addressing Performance Measure Gaps for Dementia, including Alzheimer’s Disease

  • Comprehensive diagnostic evaluation and needs assessment
    • Establish an accurate diagnosis of dementia
    • Determine functional status, living arrangements, and impact on family
    • Assess needs of person with dementia
    • Assess resources of the person with dementia
    • Evaluate driving status and other safety concerns
    • Identify a proxy/spokesperson for decisions that the person with dementia cannot or will not be able to make in the future
    • Facilitate use of advance directives
    • Identify caregiver needs (at baseline)

Quality Measures: Work in Progress

  • The Measure Application Partnership recommended to move forward with the development of these electronic clinical quality measures (eCQM)
    • Cognitive Impairment Assessment Among At-Risk Older Adults - Percentage of patients age 80 years or older at the start of the measurement period with documentation in the electronic health record at least once during the measurement period of (1) results from a standardized cognitive impairment assessment tool or (2) a patient or informant interview.
    • Documentation of a Health Care Proxy for Patients with Cognitive Impairment - The percentage of patients with a diagnosis of dementia or a positive result on a standardized tool for assessment of cognitive impairment, with documentation of a designated health care proxy during the measurement period.”

Home and Community-Based Services (HCBS)

Screen Shot of the National Quality Forum's Measuring HCBS Quality page.
www.qualityforum.org/Measuring_HCBS_Quality.aspx

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