Indiana University School of Medicine, Indianapolis, Indiana, USA.
Grossman School of Medicine, Departments of Medicine and Population Health, and VA Harbor Healthcare System, New York, New York, USA.
Alzheimers Dement. 2023 Sep;19(9):4276-4286. doi: 10.1002/alz.13376. Epub 2023 Jul 12.
Longstanding gaps in the detection of Alzheimer's disease and related dementias (ADRD) and biopsychosocial care call for public health action to improve population health. We aim to broaden the understanding of the iterative role state plans have played over the last 20 years in prioritizing improvements in the detection of ADRD, primary care capacity, and equity for disproportionately affected populations. Informed by national ADRD priorities, state plans convene stakeholders to identify local needs, gaps, and barriers and set the stage for development of a national public health infrastructure that can align clinical practice reform with population health goals. We propose policy and practice actions that would accelerate the collaboration between public health, community organizations, and health systems to improve ADRD detection-the point of entry into care pathways that could ultimately improve outcomes on a national scale. HIGHLIGHTS: We systematically reviewed the evolution of state/territory plans for Alzheimer's disease and related dementias (ADRD). Plan goals improved over time but lacked implementation capacity. Landmark federal legislation (2018) enabled funding for action and accountability. The Centers for Disease Control and Prevention (CDC) funds three Public Health Centers of Excellence and many local initiatives. Four new policy steps would promote sustainable ADRD population health improvement.
长期以来，阿尔茨海默病和相关痴呆症（ADRD）的检测以及生物心理社会护理方面的差距，需要采取公共卫生行动来改善人口健康。我们旨在更广泛地了解各州计划在过去 20 年中在优先提高 ADRD 的检测、初级保健能力以及为受影响不成比例的人群实现公平方面所发挥的迭代作用。根据国家 ADRD 的优先事项，各州计划召集利益攸关方，确定当地的需求、差距和障碍，并为发展国家公共卫生基础设施奠定基础，该基础设施可以使临床实践改革与人口健康目标保持一致。我们提出了政策和实践行动，以加速公共卫生、社区组织和卫生系统之间的合作，提高 ADRD 的检测水平——这是进入护理途径的切入点，最终可以在全国范围内改善结果。重点：我们系统地回顾了各州/地区阿尔茨海默病和相关痴呆症（ADRD）计划的演变。随着时间的推移，计划目标有所改善，但缺乏实施能力。具有里程碑意义的联邦立法（2018 年）为行动和问责制提供了资金。疾病控制与预防中心（CDC）为三个公共卫生卓越中心和许多地方倡议提供资金。四项新的政策步骤将促进可持续的 ADRD 人口健康改善。
