Recognizing Cognitive Decline in the Rural Communities: An Initiative to Improve Cognitive Screening in Adults less than 65 years old in Rural Areas

BACKGROUND: Cognitive impairment is much higher in rural areas than in urban locations. With a rapidly aging population, multiple healthcare disparities, and increasing healthcare costs, there is a critical need to implement earlier detection of cognitive decline in rural communities. Cognitive Screenings in primary care clinics show benefits through patient outcomes and have cost-effective benefits. Healthy People 2030 aims to increase the percentage of adults aged 45 and older who have confusion and memory loss and report these findings to their healthcare provider to 50.4 %.

LOCAL PROBLEM: The setting of this practice improvement project was a rural primary care clinic in Western North Carolina. There was no standardized screening process for adults ages 40-64 in this primary care setting. The purpose of the project was to standardize a screening process in the primary care setting for patients ages 40-64 at the annual visits.

METHODS: The Evidence-based Practice Improvement model provided a framework for project implementation. The clinical workflow for administering the cognitive tool was determined through PDSA (Plan-Do-Study-Act) cycles. Implementation data were measured to evaluate the screening process and compliance.

INTERVENTIONS: An educational session was conducted before the implementation of the screening process. Weekly training was provided to the clinic staff during implementation with email follow-ups to providers on the screening rates and positive screenings.

RESULTS: There were a total of 124 annual visits completed and 110 mini-cog screenings completed. This resulted in an average of 89% screening rate overall, 13% of those found to be positive for cognitive impairment, 100% were scheduled for follow up.

CONCLUSION: Implementing a standardized brief screening tool for adults aged 40-64 adults had a clinically significant impact on the detection of early cognitive decline. Sustainability plans include utilizing the electronic health record to incorporate alerts for screenings and follow-up.