Outcomes from routine cognitive screening in a health care system [abstract]
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Background: Even with routine health care, dementia often goes undiagnosed until the moderate-severe stages. The potential benefits of cognitive screening in the asymptomatic population are unclear. HealthPartners has piloted the use of the Mini-Cog as a standardized screening tool for cognitive function in patients aged 65 and older. Methods: Patients screened within specialty or primary care clinics were identified. Data from the 18 months prior to screening and the 18 months following screening were collected from the electronic medical record and included the Mini-Cog score (MC, scored 0-5), demographics, interventions received, and measures of healthcare utilization. Two definitions of screening positive were tested for the Mini-Cog (score of < 3 and < 4). Data analysis consisted of Poisson regression and normal mixed effects regression. Results: The MC was administered in 1,166 patients (average 77 yrs, 58% female). Rates of patients screening positive for cognitive impairment were 16% and 32% (MC score of < 3 and < 4, respectively). Following a positive screen, documentation of diagnostic interventions (i.e. imaging, neuropsychology) were generally low (<7%), though significantly higher than after negative screens. In the 18 months following a positive screen, patients were more likely to be diagnosed with dementia or mild cognitive impairment (14% vs. 3%, p<0.001) and to receive a prescription for a dementia medication (12 % vs. 2%, p<0.001) as compared to patients with a negative screen, regardless of cutoff score used. Patients screening positive had a significantly lower overall incidence rate of office visits (-5%) in the 18 months following screening as compared to the prior 18 months, which was more prominently seen in patients screened in primary care (-23%). Incidence of emergency room visits remained the same and hospitalizations changed significantly but differently by screen site, with significantly lower incidence in primary care screens and higher incidence in specialty care. Conclusions: Screening was associated with increased recognition of previously undetected cognitive impairment and changes in healthcare utilization. Further studies are needed to better understand what work flows may influence clinicians actions and increase the diagnostic follow-up of a positive screen.