A Telehealth Advance Care Planning Intervention in Those With Mild Cognitive Impairment or Unrecognized Dementia

Study Overview
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Brief Summary
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The purpose of this study is to pilot test a telehealth Advance Care Planning (ACP) intervention among those with either mild cognitive impairment (MCI) or unrecognized dementia. Our goal is to pilot-test and evaluate a pragmatic Telehealth ACP intervention among patients with either the diagnosis of mild cognitive impairment (MCI) or unrecognized dementia.

Detailed Description
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Telehealth has the potential to overcome barriers related to timing and travel restraints and to provide patients and their caregivers with an opportunity to discuss their goals, values, and priorities for their healthcare within their home setting. Recent studies have demonstrated patients' willingness to use telehealth and have shown that it can play an integral role in dementia care management.

Official Title
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A Telehealth Advance Care Planning Intervention in Those With Mild Cognitive Impairment or Unrecognized Dementia (Tele Voice)

Conditions
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Advance Care Planning, Telemedicine, Mild Cognitive Impairment, Unrecognized Dementia, Dementia

Intervention / Treatment
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* Behavioral: Telehealth visit


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of recognized or probable Mild cognitive impairment (MCI) or mild dementia determined by either ICD10 diagnostic codes or electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) Have decisional capacity according to their primary care physician (PCP) to complete ACP Completed visit with their PCP within the past 12 months Affiliated with an Accountable Care Organization. English-speaking Exclusion Criteria: Moderate to severe hearing loss that would preclude participating in a video or telephone intervention No phone number available for patient. Lives in a long-term care facility

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: This is a pragmatic pilot study where 300 patients with either mild cognitive impairment (MCI) or unrecognized dementia and their care partner (if available) will be approached to participate in a telehealth Advance Care Planning (ACP) visit with a member of their primary care team in hopes of enrolling 94 patients. Patients are still eligible to participate in the study even if a care partner/loved one does not attend the ACP visit with them or if the patient does not have a care partner.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Telehealth visit<br>Patients with either MCI or unrecognized dementia and their care partners (if available) will be approached to participate in a telehealth Advance Care Planning (ACP) visit with a member of the patient's primary care team via either telephone or video. Patients without willing or available care partners are still eligible to participate in the study. | Behavioral: Telehealth visit<br>* Patients with either MCI or unrecognized dementia and their care partners (if available) will be approached to participate in a telehealth Advance Care Planning (ACP) visit with a member of the patient's primary care team via either telephone or video. Patients without willing or available care partners are still eligible to participate in the study.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patient/Care Partner Agreeing to Participate | Study will measure the amount of patient or patient-care partner dyads who agree to participate. | Baseline to Month 9 | 
| Number of Participants With Telehealth Advance Care Planning (ACP) Completed | Study will measure the amount of patients or patient-care partner dyads who complete the ACP telehealth intervention. | month 9 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With One or More Advance Care Planning (ACP) Discussions | Study will measure the number of ACP discussions documented in the electronic health record. | month 9 | 
| Number of Participants Who Used One or More Advance Care Planning (ACP) Billing Codes | Study will measure the usage of ACP billing codes (99497 and 99498). | month 9 | 
| Quality of Advance Care Planning (ACP) Discussion Scores | Discussion quality will be operationalized using a scoring system derived from the ACP Wise documentation program. Score range of 0 (indicating no advance care planning questions answered) to 9 (indicating nine advance care planning questions answered). High-quality ACP discussions will be defined as addressing ≥4 out of 9 core components in the ACP discussion, with 1 point assigned if the following factors were addressed as part of the ACP discussion: Disease understanding, health-related goals, what matters most in their life, important milestones, health-related worries, named surrogate decision-maker, unacceptable states at the end-of-life (e.g. being in a coma, etc.), goals if their health was to worsen, and documentation of code status. | month 9 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dementia, telehealth, Advance Care Planning, Mild Cognitive Impairment