Table 3. Dementia Quality Indicator Pass Rates: UCLA Alzheimer’s and Dementia Care (ADC) Program compared to ACOVE Studies.
| ACOVE QI Description | ACOVE Studies with participants eligible for QI (reference number) |
ACOVE Observational Studies |
ACOVE Intervention Studies |
UCLA ADC Program |
|---|---|---|---|---|
| N Passed / N Eligible (%) | ||||
| Domain: Assessment and screening | ||||
| Annual assessment of cognition | 5-8 | 19/45 (42%) | 75/192 (39%) | 747/793 (94%) |
| Annual evaluation of function | 4, 6, 8, * | 40/629 (6%) | 52/80 (65%) | 770/797 (97%) |
| HIV/STS testing if risk factors+ | 9 | No eligible | 1/1 (100%) | 0/1 (0%) |
| Depression screening | 4, 6-9, * | 8/11 (73%) | 31/36 (86%) | 793/796 (99%) |
| Annual screen for behavioral symptoms |
6-9, * | 45/96 (47%) | 87/198 (44%) | 787/797 (99%) |
| Annual medication review | 7 | No eligible | 26/40 (65%) | 794/797 (99%) |
| Subtotal | 112/781 (14%) | 271/546 (50%) | 3892/3980 (98%) | |
| Domain: Counseling | ||||
| Caregiver counselled in at least 2 domains |
4-9, * | 42/157 (27%) | 99/269 (37%) | 789/797 (99%) |
| Counselled regarding driving | 4, 6-9, * | 3/13 (23%) | 19/94 (20%) | 740/795 (93%) |
| Subtotal | 45/170 (26%) | 118/363 (33%) | 1529/1592 (96%) | |
| Domain: Treatment | ||||
| Discussion about acetylcholinesterase inhibitors |
5-9 | 5/6 (83%) | 40/61 (66%) | 259/302 (86%) |
| Received CVA prophylaxis, if indicated |
4, 6, 8, 9, * | 8/9 (89%) | 17/18 (94%) | 64/88 (73%) |
| Treatment with behavioral interventions first or concurrently with medications |
6-9 | 11/32 (34%) | 17/108 (16%) | 368/537 (69%) |
| Risks/benefits discussion documented for new antipsychotics |
7-9 | 1/5 (20%) | 7/9 (78%) | 5/10 (50%) |
| Discontinue or justify medications associated with mental status changes |
6, 8 | 0/5 (0%) | 8/32 (25%) | 35/131 (27%) |
| Subtotal | 25/57 (44%) | 89/228 (39%) | 731/1068 (68%) | |
| Overall pass rate | 182/1008 (18%) | 479/1138 (42%) | 6152/6641 (93%) | |
All studies measured quality of care for dementia using the same 13 ACOVE quality indicators. Four quality indicators not used in all studies were excluded from the table above, including staging of dementia, counseling regarding advance care planning or palliative care, identification of a surrogate decision maker, and assessing response to new medication for dementia or depression. Adherence to TSH and B12 laboratory testing was not scored using the same method across all studies and thus was not included in the comparison. The observational study group included three observational studies4, 6 (unpublished, personal communication with Neil S. Wenger*) and two control arms from interventional studies.5, 9 The interventional study group included four interventional studies.5, 7-9 Characteristics of the ACOVE studies are provided in the Appendix.