California Dementia Partnership Update
by Tim Gieseke, MD, CMD
Member California Partnership to Improve Dementia Care
 

As many of you know the CMS 5 Star QM program as of July 2016 will include measures that will in part be a reflection of a facilities dementia care.  These include rate of return to ED, 30 day re-hospitalizations, Successful discharges to the community, Short stay residents with improved function, Long stay residents with functional decline, and the use of anxiety/hypnotic meds (data collection only at this time).

As a Medical Director and consultant, I’m spending much more time working with facilities to insure that patients with dementia have care plans that enhance their abilities and quality of life.  This requires an interdisciplinary approach with all members of the team participating in care plan development and modification.  Historically, as clinicians, we have focused too much on the role of medications in dementia management to the exclusion of non-pharmacologic approaches such as creating a dementia friendly environment and use of non-pharmacologic and targeted behavioral approaches. 

The California Dementia Partnership has created a user friendly website with resources for professionals as well as patients and their families.  This web site can be accessed at:http://www.dementiacareresourceca.org/#!professionals/c2qx . It has an excellent physician tool kit (see below link) as well as a model Informed Consent form for antipsychotics with appropriate educational resources for patients and their families.    

I would highly recommend sharing this with physicians and NP’s/PA’s who work in your facility as well as referring hospitalist programs.  As we move to integrate care, we need to promote seamless transitions for patients with dementia and delirium.

Over the years, I and many of my attending physicians have observed many GDR (gradual dose reduction) failures for antipsychotics due to a facilities failure to provide proper dementia care as an alternative to over-medication.  As we have adopted the best practices identified on the web site, I’m pleased to see that the rate of successful GDRs has dramatically increased resulting in a reduced rate of long stay resident antipsychotic use (now posted on nursing home compare).

Please encourage your staff, clinicians, and hospitalist to visit this web site and consider how some of these good ideas could become a reality in your facilities. 

At CALTCM, we are pleased that the dementia partnership work is continuing with leadership of California Culture Change and HSAG, our QIO.  For upcoming in-person training for your team, consider attending the CAHF / HSAG 2016 Quality Symposium and Outcomes Congress on Excellence in Dementia and Person Centered Care (http://www.cahf.org/MeetingsEvents/2016QualitySymposium.aspx ).