Quality measures in dementia care across a network of memory clinics: An implementation study

Background In 2015 the American Academy of Neurology and American Psychiatric Association updated the Dementia Management Measurement Set from 2009. Out of the nine measures proposed, four have been included by the Centers for Medicare and Medicaid Services (CMS) in their Merit‐Based Incentive Payment System, which is used to determine payment adjustments in pay‐for‐reporting program. In 2018, the Wisconsin Alzheimer’s Institute (WAI) developed a process to track the performance of these measures across the WAI Dementia Diagnostic Clinic Network, which consists of 44 statewide clinics across 24 healthcare systems. Method In September 2018, WAI launched the following implementation strategies to improve adoption of the quality measures: audit and feedback, new de‐identified forms, and development of a codebook with definitions and examples on how to fill the new forms. Clinics submit de‐identified forms containing demographics, diagnosis and process measures that are used to calculate performance on the quality measures. Descriptive analyses were performed, and performance was calculated according to criteria set by CMS. Result Over 24 months, 23 clinics have submitted information on 3,247 patients. Early adopters demonstrated a high performance on the measures, but as more clinics participate, the distribution has shown regression to the mean (Table 1). When comparing clinic performance between Oct 2019 – Oct 2020 with CMS benchmarks for 2020, the percentage of clinics performing above the CMS average were: 68% for measure #2; 91% for measure #3; 48% for measure #4; and 86% for measure #5 (Figure). Variations in performances have been attributed to unique characteristics of each clinic, for example, some do not follow‐up individuals and only provide recommendations to primary care providers; this lowers their metrics in measures that require management of behaviors or conditions. Conclusion Implementation of the quality measures across the WAI network has been facilitated by the use of clinical care models that promote interdisciplinary care. Further research is required to explore additional mechanisms that increase participation of clinics, and to develop new data collection methods that can explore the impact of these measures on health outcomes.