Patricia A. Chin School of Nursing, California State University, Los Angeles, CA, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241277397. doi: 10.1177/21501319241277397.
Beyond our population growing older and living longer, there is an increased risk of developing a cognitive disorder. Standardized screening during a routine visit in primary care may be ideal for early detection of mild cognitive impairment (MCI) and follow-up for cognitive changes.
This quality improvement (QI) project aimed to determine the impact of implementing the Mini-Cog© quick screening for early dementia detection to identify and follow up on the cognitive impairment of older adults in a primary care clinic setting.
Implementation started in February 2024 in a primary care clinic in Southern California. Data was collected for this project over a total of 16 weeks. This QI project implemented a routine cognitive screening using the Mini-Cog©. Cognitive impairment was identified, and if indicated by the Mini-Cog© scores, follow-up for a cognitive assessment and care plan services were initiated. Data were obtained from the project site's electronic medical record on a total sample size of 471 participants (n = 382 in the pre-implementation group and n = 89 in the post-implementation group).
Pearson's chi-square test indicated a statistically significant improvement in the identification rate of cognitive impairment, increasing from 11.8% (n = 45 out of 382) at pre-implementation to 34.8% (n = 31 out of 89) at post-implementation, and specifically, mild cognitive impairment increased from zero identified in pre-implementation to 12.4% (n = 11 out of 89) post-implementation. Lastly, follow-up rates improved from 91.1% (n = 41 out of 45) to 100% (n = 31 out of 31) in post-implementation, and clinical significance was evident based on the phi-coefficient ( = 0.196), indicating a small effect size and a 100% follow-up rate.
The findings of this project suggest older adults should receive cognitive screenings to help identify early cognitive impairment and increase follow-up for further evaluation, treatment, and advanced care planning.
除了人口老龄化和寿命延长之外，人们患上认知障碍的风险也在增加。在初级保健常规就诊期间进行标准化筛查可能是早期发现轻度认知障碍（MCI）并对认知变化进行随访的理想方法。
本质量改进（QI）项目旨在确定实施 Mini-Cog©快速筛查以早期发现痴呆症来识别和随访初级保健诊所中老年患者认知障碍的影响。
该项目于 2024 年 2 月在加利福尼亚州南部的一家初级保健诊所开始实施。本项目共收集了 16 周的数据。该 QI 项目使用 Mini-Cog©进行常规认知筛查。如果 Mini-Cog©评分提示认知障碍，则进行认知评估和护理计划服务的随访。数据来自项目现场的电子病历，总样本量为 471 名参与者（n=382 名在实施前组，n=89 名在实施后组）。
Pearson's 卡方检验表明认知障碍的识别率有统计学意义的提高，从实施前的 11.8%（n=382 中的 45 例）增加到实施后的 34.8%（n=89 中的 31 例），特别是轻度认知障碍从实施前的零例增加到实施后的 12.4%（n=89 中的 11 例）。最后，实施后的随访率从 91.1%（n=45 中的 41 例）提高到 100%（n=31 中的 31 例），并且基于 phi 系数（ = 0.196），临床意义明显，表明小效应量和 100%的随访率。
本项目的研究结果表明，老年人应接受认知筛查，以帮助识别早期认知障碍，并增加随访，以进行进一步评估、治疗和高级护理计划。
