| Description |
Background: The largest growth in patients with diabetes is expected to be in those over the age of 65. Two risk factors for developing dementia include age and diabetes. In fact, type 2 diabetes increases dementia risk two-fold. About 50% of the time, dementia is preceded by mild cognitive impairment. Mild cognitive impairment and dementia can be detected utilizing objective screening tools such as the mini-cog. The American Diabetes Association (ADA) recommends that patients with diabetes age 65 and older should be screened annually for cognitive impairment. However, this recommendation is not routinely implemented in diabetes clinics. The purpose of this quality improvement project was to improve the implementation of cognitive screenings (mini-cog) on older adults with diabetes and to increase provider understanding of screening recommendations. This project was performed at a large University of Utah diabetes clinic in Salt Lake City, Utah. Methods: In this quality improvement project, congruence data was obtained to assess for discrepancies between the mini-cog score of a patient with diabetes and the providers' documentation of the patient's cognitive status. A pre-survey was administered to assess for provider gaps in knowledge, followed by a training describing congruence data, pre-survey results, and the current recommendations for cognitive screening. Post survey data was collected through additional surveys to assess perceived usability, and satisfaction with the mini-cog and clinical recommendations and reported to key stakeholders. Based on provider and key stakeholder responses indicating that they felt it was the primary care provider's responsibility to screen for cognitive impairment, changes were made to the project. Data from the electronic data warehouse was obtained to determine if cognitive screenings were, in fact, being performed in primary care during Medicare annual wellness visits, which requires an objective cognitive screening.Results: Five providers completed the pre survey and three completed the two-month post survey. Those providers who completed this post-survey did not show a change in practice (0%, N=3). Barriers to provider screening included lack of time, resources, fear the providers would upset the patients and uncertainty about what to do if a patient's screening was abnormal. Key stakeholder meetings with the medical director of the clinic demonstrated that in general, they felt it was the primary care provider's role to screen for cognition, not the diabetes specialists' role. Data from the data warehouse demonstrated that, on average, only 14.1% of patients with diabetes age 65 and older who receive an annual Medicare wellness visit have cognitive screening documented. Conclusions: Results from this project showed that various barriers prevent diabetes specialists from screening for cognitive impairment as recommended by the ADA.It also found that cognitive screenings are not uniformly recognized as a diabetes specialty provider role. However, data showed that cognitive screenings are not routinely performed in primary care clinics. Thus, further research is needed to help address this gap, such as using diabetes educators to implement cognitive screenings as well as the use of further objective data to help providers understand the scope of the problem within their own practice. |
