New Quality Measures Define Top-notch Dementia Care

Megan Brooks

May 08, 2017

Updated quality measures for the care of patients with dementia encourage physicians to disclose the diagnosis to patients and caregivers.

This is an "especially important and potentially controversial" new addition to the measures on high-quality dementia care, the American Psychiatric Association (APA) acknowledged in a press release.

"There is reluctance on the part of physicians to have this conversation because we really have no definitive disease-altering treatments, so physicians are concerned about the impact of the diagnosis on patients and caregivers," Robert Paul Roca, MD, MPH, chair of the APA Council on Geriatric Psychiatry and co-chair of the working group that updated the dementia quality measures, told Medscape Medical News.

"But we know that people want to know what ails them. They don't want diagnoses withheld from them, so we felt it was important to include a measure that would prompt people to disclose the diagnosis," said Dr Roca.

Dr Robert Paul Roca

"The fact that it's in the measure set will make it clear to physicians that the best practice includes revealing the diagnosis, both the diagnosis of the syndrome of dementia and the underlying condition that is most likely causing it," he noted.

Sam Fazio, PhD, director of special projects for the Alzheimer's Association, told Medscape Medical News that the diagnosis disclosure measure is a "great addition," one the Alzheimer's Association "enthusiastically supported. Everybody deserves to know the truth about their diagnosis."

The original Dementia Management Quality Measurement Set was developed and published in 2013 by the American Academy of Neurology (AAN) as part of the Physician Consortium for Performance Improvement of the American Medical Association. In 2015, the AAN and the APA formed a multidisciplinary work group made up of 26 individuals representing 21 organizations to update and improve the original measures.

The APA and the AAN are now the "stewards of the measure set," Dr Roca said. "Quality measures have a shelf life, and after several years, it's necessary to review new evidence and new guidelines to make sure that the quality measures are aligned with the guidelines, so it was time to do this."

The group reached "broad consensus" on what constitutes quality of dementia care today, he noted.

The second of the three new quality measures focuses on assessing pain in patients with dementia. Assessing pain is "important because patients with dementia, especially advanced dementia, can't articulate symptoms very clearly," said Dr Roca. "And sometimes pain is giving rise to agitation and other behavioral symptoms that are burdensome to caregivers as well as difficult for patients. Actively inquiring whether pain may be present offers the opportunity for patients to receive treatment."

The third new measure centers on treatment and emphasizes pharmacologic treatment, when appropriate, within treatment rubrics that include nonpharmacologic behavioral and lifestyle modifications.

Dr Roca said it's "rather remarkable that there was no quality measure related to treatment until now. This is partly because I don't think the field is satisfied with the treatments that are available. But there are FDA-approved pharmacologic treatments for dementing illnesses that are at least worth considering and offering to patients and caregivers, and there are also a host of nonpharmacologic approaches to treatment that are vital to also present to caregivers and patients," he said.

The updated dementia care quality measures were published online May 1 in the American Journal of Psychiatry and Neurology. A summary for clinicians is also available online.

Am J Psychiatry. Published online May 1, 2017. Abstract

Neurology. Published online May 1, 2017. Abstract

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