Methods for identifying high-risk patients in primary care settings have raised the possibility of timely enhancement of care for detected patients. The authors conduct a scoping review to identify existing measures of care quality, guidelines, and tools that (1) assess social support, the need for caregiver support, and the need for referral to social services and (2) screen for cognitive impairment among patients with complex health care needs.
A Scoping Review of Guidelines and Quality Measures to Screen for Social and Caregiver Support and Cognitive Impairment in Primary Care
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Research Questions
- What guidelines and quality measures exist regarding assessment of social support of high-risk patients with complex care needs?
- What assessment questions or tools are used in primary care to quickly identify (need for) social support of high-risk patients with complex care needs?
- What guidelines and/or quality measures exist regarding screening high-need patients for CI in the primary care setting?
- What screening tools are currently used in the primary care setting to briefly screen for CI, and what is their evidence base?
High-risk patients — those patients with complex health care needs who are most likely to face hospitalization or death in the following two years — are most often initially seen in the primary care setting. This small group of patients uses a disproportionate amount of care resources. Contributing to the challenges of care planning for this population is that individuals are highly heterogeneous; no two patients present the same set of symptoms, diagnoses, and challenges related to social determinants of health (SDOH).
Methods for early identification of these high-risk patients — and their care needs — have raised the possibility of timely enhanced care. In this study, the authors conduct a scoping review to identify existing measures of care quality; assessment and screening guidelines; and tools that (1) assess social support, the need for caregiver support, and the need for referral to social services and (2) screen for cognitive impairment (CI). Evidence-based screening guidelines define who and what should be assessed — and how often — to enhance care quality and improve health outcomes, whereas measures permit ascertainment that this assessment is occurring. Evidence-based guidelines and measures — those that are found to lead to better health care outcomes — would be candidates for inclusion in a measure dashboard for high-risk patients in primary care settings.
Key Findings
Social Support
- Social support, as conceived by the tools and other resources identified, encompasses at least two concepts: help when needed with performing activities of daily living (ADLs) and presence of emotional support (i.e., the absence of loneliness or social isolation).
- We identified no existing quality measures for assessing existing social or caregiver support or the need for referral to social services in primary care settings.
- One identified guideline provided a decision support tool for assessing the need for social or caregiver support. No information on implementation or validation was found.
- Many tools exist for assessment of ADLs and SDOH in primary care settings, and some of these tools include items to assess social support, need for further caregiver support, and need for referral. None of the tools was adapted for patients with complex care needs or validated using health or other important outcomes.
Cognitive Impairment
- We identified several quality measures and evidence-based guidelines for screening patients for CI in primary care settings, although routine screening of patients who do not present with evidence of CI remains controversial.
- Numerous brief screening tools exist for assessment of age-related CI, and several tools exist for screening for CI associated with chronic conditions. Most of these tools have been validated against specialty assessment, and some have been compared in the same populations.
- No one screening tool appears to be ideal, but some candidates exist. Nevertheless, several challenges, including the lack of validation among diverse populations, must be overcome for all CI screening.
Table of Contents
Chapter One
Background and Approach
Chapter Two
Approach and Methods
Chapter Three
Assessing Social Support, Caregiver Support, and Need for Social Services in the Primary Care Setting
Chapter Four
Assessing Cognitive Impairment in the Primary Care Setting
Chapter Five
Discussion
Appendix A
Search Strategies
Appendix B
Evidence Tables
Appendix C
Excluded Studies and Background Literature
Research conducted by
This research was funded by the Veterans Health Administration (VHA) and conducted by the Access and Delivery Program within RAND Health Care.
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