Program Parameters

• This Action will determine the need for Actions 2-4.

• Ensure the proposed program model and evaluation framework align with the funding provider’s decision-making criteria.

• Your core team may need to seek private funding if your healthcare system lacks relevant grants or other funded programs.

• Once you have received funding, review how that might impact your program model and evaluation plan and adjust as necessary.

• Identify the outcomes and specific metrics that indicate the program’s success (e.g., number of cognitive assessments conducted, number of positive screenings, number of referrals, etc.).
• Decide on the data collection tools and methods for each metric. This may involve accessing existing data sources, conducting surveys or interviews, engaging focus groups, or implementing a new IT system. There are many structured frameworks from quality improvement, implementation science, and program evaluation you may use to guide this activity.

• Formalize your monitoring processes to track outcomes and adherence to clinical protocols. Consider measures of clinical process, and individual factors such as attitudes and behaviors of the staff and patients involved.
• Include ongoing reporting intervals to communicate the program’s progress to your key stakeholders, in alignment with the governance structure and communications schedule defined in Goal 4.
• Integrate your process monitoring into the team’s meeting and reporting cadence so issues are regularly documented and assigned to owners for remediation.

• Test characteristics such as diagnostic accuracy, psychometric properties, and sensitivity to disease severity;
• Assessment domains such as cognition, functional capacity, behavior and lifestyle, patient characteristics and symptom history;
• Clinical administration complexities such as how the tool or assessment process fits into the clinical practice and workflow, time-effectiveness, and environmental factors;
• Ease of use and accessibility, including if staff is required to administer the test or if it is self-administered, applicability for the language, education, culture, and literacy of your target population;
• Technical requirements such as if a dedicated device is required, if internet access is needed, if the tool can integrate with medical records;
• Regulatory approval status; and,
• Cost of the tool and your available (and ongoing) funding for the tool.

• It is strongly advised that you review academic publications about available cognitive assessments for the most current recommendations.
• One such example is Expanding the use of brief cognitive assessments to detect suspected early-stage cognitive impairment in primary care (Mattke et al., 2023).

Mattke et al. recommend selecting a cognitive assessment tool that meets the following criteria:

• Takes less than 10 minutes to complete;
• Achieves at least 80% specificity and sensitivity for detecting mild cognitive impairment or mild dementia;
• Is available in various languages and appropriate for people with all educational backgrounds;
• Is available in affordable, low-cost digital and/or paper-based formats;
• Has data fields that can be integrated into electronic health records or entered manually; and,
• Has been tested and validated in diverse populations.

Understand how the tool will be used in a clinical setting and how those who administer it will incorporate it into their workflow.

• Interview the medical professionals who will engage with the tool (e.g., primary care providers, medical assistants, etc.) to understand their needs and preferences.
• Gain an understanding of how they will administer the tool, time to administer, the ease of clinical decision-making, data capture and transfer, and any other administrative or clinical considerations or risks.
• Use this information to select potential cognitive assessment tools and engage these stakeholders in the final decision-making around which tool your program will use.

• Ensure a good fit between the clinic environment and the cognitive assessment tool. For example, a busy clinical environment with background noise and lots of movement increases the risk of false positives. You will want to control environmental factors that can influence the test results (e.g., by designating a quiet office area for conducting tests, ensuring adequate lighting, etc.).
• For digital cognitive assessment (DCA) tools, you will need to consider your technology integration and environmental factors such as WiFi, charging, software updates, secure storage, and required logins. If you select a DCA, you will need to create operational processes for how to maintain, update, and troubleshoot these tools.

• Consider what type of resources will be needed to implement the tool. In addition to financial requirements, it may require technological and human resources. For example, if a medical assistant will administer the test instead of a neuropsychologist with rater training, you may consider a tool that’s self-scoring. The cognitive assessment data also may need to be integrated into the existing electronic medical records (EMRs) manually by the staff, which requires time and resources.
• If possible, find ways to work within existing programs and tools to minimize the new tasks that staff will need to learn and adopt to implement the program.