Reducing Referral and Access Barriers to Early Cognitive Screening and Assessment
Background and significance:
Many patients assessed by the Memory and Aging Center at UCSF Health are well insured with caregiver support and not from underrepresented racial and ethnic backgrounds. They do not represent the San Francisco Bay Area’s regional diversity seeking specialty referrals. With longevity and the chronic conditions of aging, the United States will have an estimated 14 million adults with some type of dementia by 2060, with women and minorities most impacted (The Truth About Aging and Dementia | CDC, 2019). Strategies addressing disparities in access will be essential.
Project aims:
This project aims to: 1) identify barriers in the referral process for dementia care; 2) engage patients, caregivers and providers in a community and ED setting to improve early detection, and 3) ensure access equity.
Design:
In November 2021, two neuro-cognitive evaluation pathways to the Memory and Aging Center have been implemented. The first engages community dwelling patients through partner agencies while the second engages patients through a partnership with the Age-friendly Geriatrics Consult Service focusing on the emergency department. The community partner pathway identifies patients through collaborative events between the UCSF Memory and Aging Center Outreach team and community organizations. The Age-friendly ED Consult partnership pathway utilizes a direct referral system for patients that leverages the cognitive assessments completed by the consult service. The main community organizations engaged include the Alzheimer’s Association of Northern California, Dr. George W Davis Senior Center, and the UCSF Black Health Initiative. The interdisciplinary team includes a nurse practitioner/doctoral student, neurologist, social worker, clinical research coordinator, patient care coordinator (insurance approval), and clinical nurse.
Results:
The project began in November 2021. Fifteen patients have been referred from the community and seven from the Age-friendly Geriatrics ED Consult Service. Three have completed a neuro-cognitive evaluation at the UCSF Memory and Aging Center. Referral process data has been collected for all referred patients.
Conclusion:
Primary barriers thus far for community referrals include: 1) lack of comprehensive referral from PCP; 2) insurance non-compatibility; 3) patient-centered barriers. Accompaniment from caregivers and families, same day reminder communication, pre-arranged transportation, timed outreach to community primary care providers, assisting with the triage requirements, and creative insurance approval solutions may address referral barriers.
Reflections:
Overseeing patient referral challenges and shepherding the process requires an interdisciplinary team including families, caregivers, community agencies, and provider engagement. Reduction in barriers to dementia assessment specialty referrals will require creative solutions.
