Failure on cognitive screening predicts increased healthcare utilization [poster]
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Background/Aims: Most physicians fail to diagnose dementia until the moderate-severe stages. Cognitive screening for dementia in the asymptomatic population is not routinely performed due to the absence of evidence showing improved health outcomes. HealthPartners has piloted the use of the Mini-Cog as a standardized screening tool for cognitive function in patients aged 65 and older in order to assess the impact of undetected cognitive impairment on chronic disease management and healthcare utilization. Methods: Patients screened within specialty or primary care clinics were identified. Data from the 18 months prior to screening was collected from the electronic medical record and included the Mini-cog score (scored 0-5, fail is less than 4), demographics, presence of diagnosis for four chronic diseases (diabetes, hypertension, hyperlipidemia, heart disease), measures of chronic disease management (HbA1c, blood pressure, lipid panel, INR levels), and measures of healthcare utilization. Data analysis consisted of Poisson regression and normal mixed effects regression. Results: The Mini-Cog was administered in 753 patients (average 77 yr, 58% female) and 33% failed screening. No significant differences in chronic disease management were identified in the 18 months prior to screening between the patients that passed and failed. However, patients failing the Mini-Cog had a significantly higher incidence rate of hospitalizations (24%), emergency room visits (58%), appointment no shows (76%), cancelled visits (23%), and phone encounters (11%). In a sub-analysis, patients failing screening in specialty care (193 of 554) had a higher incidence rate of appointment no shows (82%), but no difference in hospitalizations. In contrast, patients failing screening in primary care (56 of 199) showed a more profound effect on crisis driven care (a 134% and 411% increase in hospitalization and emergency room visit rates, respectively compared to those passing), but no difference in appointment no shows. Conclusions: Standardized cognitive screening in older adults has the potential to not only diagnosis dementia at its earliest stages, but also to identify at-risk individuals with higher healthcare utilization. The next step is to examine post-screen data for any changes in chronic disease management or healthcare utilization.