A novel platform to facilitate provider adoption of cognitive care planning

SUMMARY Alzheimer's Disease and Alzheimer's Disease and Related Dementias (AD/ADRD) are progressive diseases in which patients’ physical and cognitive abilities decline precipitously over time. Although there is currently no cure and very few pharmaceutical-based treatment options, some interventions can help improve patient health and quality of life. Cognitive care planning (CCP) refers to the practice of systematically compiling and communicating personalized recommendations and directions for follow-up care to AD/ADRD patients. This activity can lead to better care management, thus benefiting the health and well-being of both patients and their caregivers. Despite this, CCP is scarcely seen in routine care and several barriers attribute to the slow adoption rate. First, CCP is time consuming due to the sizable amount of content to assemble; cognitive assessment data, emotional health status, and caregiver knowledge, to name a few. Second, the expertise required to interpret patient information and generate individualized recommendations for care can be daunting to non-specialists; whereas due to a shortage of dementia specialists, the burden of care for this patient population most often falls to non-specialist primary care physicians (PCPs). The considerable time invested into developing a care plan results in a financial barrier as well. In 2018 a new billing code was established to address this but reimbursements rates remain low. BrainCheck has an overarching goal to enhance the adoption of formal CCP as part of routine care for AD/ADRD patients. We have developed an app-based tool that integrates assessment scores, provider input, and patient/caregiver reported data to generate an individualized, easy-to-read document to be delivered during a clinic visit. A prototype of this tool, BC-Care™, was positively received by an initial group of specialist and non-specialist users and their feedback was used to iterate on key features and user interface design. Moreover, clinical practices reported greater success in claiming Medicare reimbursement after using BC-Care. Based on this preliminary work, we believe BC-Care makes care planning faster, more accessible, and more likely to be reimbursed. Here, we propose Phase II studies to systematically validate the impact of BC-Care on the adoption of CCP. Specifically, we will: measure the time spent on care planning, care plan completion rate, and reimbursement success rate for providers using BC-Care (Aim 1); compare the extent to which providers adopt care planning before and after gaining access to the BC-Care tool (Aim 2); and track specific impacts on health and well-being among patients and caregivers who received a care plan via BC-Care compared to those receiving care-as-usual (Aim 3). By addressing three of the major barriers preventing providers from offering care planning services to their patients with AD/ADRD, we predict our technological solution will substantially enhance adoption, thus offering a realistic path toward improving health and well-being by improving the approach to routine cognitive care.