Table 1.

Focus areas to improve AD care.

A. Focus area 1: establish awareness
	Raise awareness of clinical value for early detection	Educate about what to look for during early detection	Train nondementia-focused HCPs to act for their patients with early-stage AD	Design an ideal process to detect patients with early-stage AD
Tactics	•Build awareness in the general population, including with patients and care partners • Educate non-dementia-trained HCPs about the clinical value of early detection	•Collect data from population databases and registries to identify risk factors and detect early-stage AD • Collect individual longitudinal data	•Train HCPs to proactively detect and support the patient • Train HCPs to refer the patient to a dementia care team	•Follow an accessible, step-by-step process, designed to stratify patient risk and help HCPs determine if a patient continues to assessment • Patient questionnaire: Assess for risk of cognitive impairment • Risk stratification: Build risk profile for cognitive impairment • Care team refer: Referrals per cognitive impairment profile
Guidance and examples	•AD experts to promote broad communication and disseminate available materials • Partner with large specialty centers and geriatric groups • Targeted information for specific subpopulations • Leverage web-based, nontraditional, and established channels	•Include information such as age, sex, race, education, and norms for each patient in databases for context • Must caution that outcomes can vary • Could support future mobile monitoring	•Train HCPs in diagnosis (including cognitive tests and available biomarkers) • Provide clear guidance for HCPs regarding current reimbursement codes • Characterize the HCP as a sentinel to refer patients to specialists • Provide referral analysis and support • Be available for outreach, tools, and communication support	•Appeal to policy makers to design new reimbursement codes focused on early detection of disease with feasible requirements for primary care providers
B. Focus area 2: develop patient-centered support
	Create a care coordination team to help patients navigate their journey		Increase access to services and information to increase patient engagement
Resources required	•Training programs or certifications within clinic or larger healthcare system, such as a specialized program for interested nurses • Initiatives to impact policy around paying for these changes; can use grants for some clinics • Large group of volunteers, either intrinsically motivated or leveraging those already in settings like nursing homes, to disseminate nonexpert info • A patient resource toolbox • A clear economic case for additional resources		•Existing or new web platform • Designated individuals to respond to questions and proactively contact concerned patients and care partners (care coordinator; see previous recommendation)
Potential impact	•Eases patient and care partner stress associated with the diagnostic process (leading up to and after diagnosis) • Helps destigmatize AD • Empowers patients to seek clinics and care • Increases the quality of patient-to–healthcare system conversations, ensuring that the right information gets to patients when they need it • Increases capacity of HCPs • Improves patient adherence to recommendations		•Eases patient and care partner stress associated with the diagnostic process (leading up to and after diagnosis) • Helps destigmatize AD • Empowers patients to seek clinics and care; positions patients to be their own advocates • Increases the quality of patient-to–healthcare system conversations, ensuring that the right information gets to the right patient at the right time • Protects patients from misinformation/predators by giving them increased access to quality information • Increases number of potential patients with AD in the system receiving optimal care • Increases detection of early-stage AD • Increases capacity of HCPs • Decreases patient dropout rates and improves adherence and persistence
Guidance and examples	In a comprehensive clinic: • Designated person within clinic to help patients navigate journey • Care coordination team may be a certified volunteer group In an individual practice: • Designated person(s) outside clinic (e.g., a network of RNs) who are covered via Medicare • Group-setting sessions with a local volunteer HCP to address general AD questions • Lunch and learns with willing practitioners to address concerns		•Online assessment tools and questionnaires on major AD-related websites (e.g., Alzheimer's Association) • A checklist of steps or touch points within a patient journey detailing what is required from the patient at each step to increase patient confidence • A forum on national, association-supported portals where submitted questions are answered by care coordinators • Name and contact information fields to facilitate follow-up • Peer-support or mentoring programs for new patients (e.g., similar to oncology)
C. Focus area 3: build processes and capacity for integrated care teams
	Establish a value case to develop cross-functional teams in clinic		Educate future dementia-trained HCPs
Key considerations	•A business case to generate senior management support and buy-in, including the following:      •Direct and indirect costs      •Avoided costs      •Holistic patient cost      •Patient and care partner satisfaction      •Outcomes • An understanding of different types of patients or cases and how they might experience the care model • Decision on inclusion of research component • Communication of full scope of services for the broader community • Clear information flows within the clinic and with external stakeholders • IT systems that facilitate cross-team communications • More efficient intake options, potentially sending patients packages with tests before their visit so clinic staff can appropriately identify whom patients should see or if patients are appropriate for the clinic • Triaging of patients to the appropriate team resource • A list of resources and people providing relevant services • Informational and decisional support		•Curriculum that includes computer-based tools, neuropsychology tests, and information on conducting LPs • Interactive video training modules on AD case finding and diagnosis that NPs/PAs can use • CME courses for specific diagnosis-related topics • Annual congresses with dementia-trained HCPs to standardize and share best practices • Membership to professional association to share best practices • Dementia certifications
Potential impact	•Better outcomes for lower cost • Increased efficiency • Lower total costs when considering patient health in its entirety • Increased readiness for early-stage AD management		•Larger base of dementia-trained HCPs who can diagnose dementia

AD, Alzheimer's disease; CME, continuing medical education; HCP, healthcare professional; IT, information technology; LP, lumbar puncture; NP, nurse practitioner; PA, physician assistant; RN, registered nurse.