COMPAS-D
A cluster RCT to improve the quality of care for patients
suspected of cognitive impairment in primary care
Pim van den Dungen1, Hein van Hout1, Eric Moll van Charante2, Harm van
1
1
Marwijk , Henriëtte van der Horst
1 Department
of General Practice and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam.
2 Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
All patients ≥ 65 years
N = 7798 patients, 16 PCPs
Background
Diagnosis and management of patients in whom cognitive
impairment is suspected are suboptimal. Education of
providers, and collaboration between family physicians
(FPs) and practice nurses in a structured approach may
improve care for these patients.
Research questions:
1) To what extent does pro-active case-finding of Mild
Cognitive Impairment (MCI) and dementia
increase the number of diagnoses in patients
suspected of cognitive impairment by FPs?
2) To what extent does case-finding and subsequent
collaborative care improve the quality of
(diagnostic) care in patients diagnosed with
MCI or dementia diagnoses?
3) Do case finding and collaborative care improve the
wellbeing, meet the information needs and
decrease worrying of patients diagnosed with
dementia or MCI and their relatives?
All patients with possible cognitive
impairment according to FPs
N = 650
Random sample
N = 312
Measurements
Baseline
0.5 year
1 year
Design, setting and study population
The cluster RCT is executed in 16 primary care practices
(PCPs) among 312 patients ≥ 65 years in whom FPs
suspect cognitive impairment.
Intervention: collaborative diagnostic evaluation
and management
1. Patients with suspected cognitive impairment are
invited for a comprehensive geriatric assessment,
including a cognitive screening, by a trained practice
nurse.
2. If this assessment suggests the presence of MCI or
dementia, it is followed by a more thorough assessment,
including physical and neurological examination and
laboratory tests, by the FP.
3. When this results in a MCI or dementia diagnosis,
patients will be offered collaborative care by the practice
nurse in close collaboration with the FP. This consists of
psycho education and support. In addition care will be
coordinated by the practice nurse according to their
needs as identified by the geriatric assessment.
Control: Care as usual will be offered by the FP.
Intervention
group
8 PCPs
Control group
8 PCPs
- Patient and
caregiver
characteristics and
outcomes (n =156)
- Patient and
caregiver
characteristics and
outcomes (n =156)
- CAMCOG (n =156)
- CAMCOG (n =156)
- Outcomes in
patients with a
baseline diagnosis
MCI or dementia &
caregivers (n ~ 100)
- Outcomes in
patients with a
baseline diagnosis
MCI or dementia &
caregivers (n ~ 100)
-CAMCOG
(n = 156)
-CAMCOG
(n = 156)
- Diagnostic quality
indicators (N=156).
- Management
indicators in patients
with MCI or
dementia (n ~ 50)
- Diagnostic quality
indicators (N=156).
- Management
indicators in patients
with MCI or
dementia (n ~ 50)
- Outcomes in
patients with MCI or
dementia &
caregivers (n ~ 100)
- Outcomes in
patients with MCI or
dementia &
caregivers (n ~ 100)
Main study parameters
Objective 1-2:
-Number of MCI and dementia diagnoses after 1 year follow-up.
-23 indicators of the quality of the diagnostic process and
subsequent care.
Objective 3:
- Patient: quality of life (EQ5D, QoL-AD); mental health
(MH5)
- Caregiver: mental health (GHQ 12); burden (SSCQ);
quality of life (EQ-5D)
Baseline results:
4,4% (SD 1,7%) of all patients ≥ 65 yrs was diagnosed
with dementia. Cognitive impairment was suspected in
13,4% (SD 5,6%).
Further results expected in 2012.
Contact: P. van den Dungen, Dept. of General Practice VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Email: p.vandendungen@vumc.nl