Section 1

Setting and Leadership Team

In our previous experience with implementation research across global healthcare systems, understanding current health system structure and identifying cross-functional leadership is critical for program success. We strongly encourage all applicants to secure institutional and leadership support that will optimize collaborations across key functions in the primary care setting of your health system.

1.2 Project Leadership

Describe your clinical/leadership team who are collaborating on this US Fellowship Program and their anticipated roles in project planning and execution.

Primary care physician(s), advanced practice provider(s), and/or staff.

Character limit exceeded:

0/2100

Leader(s) with experience in change management and/or implementing new programs for sustainable practice changes within primary care settings.

Character limit exceeded:

0/2100

Champion(s) or executive sponsor(s) within your organization who can advocate for the program’s adoption and sustainment.

Character limit exceeded:

0/2100

Champion(s) or super user(s) of the electronic medical record (EMR) and/or information technology (IT) partners that can help drive changes to clinical workflows in the medical records.

Character limit exceeded:

0/2100

1.3 Patient Population

The learnings from the US Fellowship Program will be shared and applied in other health systems. Therefore, it is important that there is diversity within the patient population at participating institutions.

Describe your healthcare system’s patient population by providing an estimate of the number of patients that visited your healthcare system in 2023 across the following key demographics:

Age

Approximate % of patients aged 65 years and older:

Approximate total patient population:

Gender

Proportion of male patients ≥ age 65:

Proportion of female patients ≥ age 65:

Ethnicity and race

Approximate proportion of patients ≥ age 65 that identify as Hispanic or Latino:

Approximate proportion of patients ≥ age 65 that identify as Not Hispanic or Latino:

Approximate proportion of patients ≥ age 65 that identify as American Indian or Alaska Native:

Approximate proportion of patients ≥ age 65 that identify as Asian

Approximate proportion of patients ≥ age 65 that identify as Black or African American:

Approximate proportion of patients ≥ age 65 that identify as Native Hawaiian or Other Pacific Islander:

Approximate proportion of patients ≥ age 65 that identify as White:

Briefly describe how your proposed site of care for this program reaches a diverse population of patients in your community.

Character limit exceeded:

0/2100

1.4 Potential for Impact

How will this US Fellowship Program support your healthcare system to improve your practice for detecting and caring for patients with cognitive impairment and their families?

Character limit exceeded:

0/3000

Describe an example of how your team has previously managed changes to clinical practice within your healthcare system (e.g., research in primary care setting, implementation research, evidence-based approaches, quality improvement project, etc.).

Character limit exceeded:

0/3000

Section 2

Diagnostic Care Pathways

The US Fellowship Program intends to be a catalyst for healthcare system transformation by using and evaluating the Early Detection Blueprint for Cognitive Impairment. Responses to this RFI will help us understand your current practice and will not be evaluated based on perceived strengths or weaknesses.

In this secton, we are looking to understand your approach at each of the following phases:

Current clinical practice
Ideal future clinical practice
Sustainable activities

2.1 Current Clinical Practice

Describe your current clinical practice for identifying patients at risk for cognitive issues (e.g., screening programs, EMR triggers/flags for risk factors, Medicare Annual Wellness Visit, etc.).

Character limit exceeded:

0/2100

Describe your current clinical practice of assessing cognitive function using any formal and/or informal cognitive tools or measures (e.g., MMSE, MoCA, Mini-Cog, clock draw, etc.).

Character limit exceeded:

0/2100

Describe your current clinical practice after identifying patients with symptoms of cognitive impairment (e.g., referrals to specialists, community resources, or care coordinator; ordering imaging or other tests; etc.)

Character limit exceeded:

0/2100

Describe any existing challenges or limitations you have experienced in your current clinical practice for detecting and caring for patients with cognitive impairment.

Character limit exceeded:

0/3000

2.2 Future Clinical Practice

Describe possible opportunities for improving future clinical practice for detecting and caring for patients with cognitive impairment.

Character limit exceeded:

0/3000

Describe any barriers you expect to encounter as part of the implementation or sustainment of this program in your healthcare system.

Character limit exceeded:

0/3000

2.3 Sustainable Activities

Describe the strategies you will employ to ensure that early detection of cognitive impairment continues in your healthcare system beyond the support provided by this US Fellowship Program.

Character limit exceeded:

0/3000

Section 3

Implementation Early Detection in Primary Care

The goal of the US Fellowship Program is to use and evaluate the existing Early Detection Blueprint for Cognitive Impairment and build additional content that is US-focused. The learnings from this program will be synthesized and shared with other healthcare systems to help accelerate the transformation of dementia care.

3.1 Program Participants

How will you identify appropriate sites of care and practitioners to deploy early detection programs in your healthcare system?

Character limit exceeded:

0/2100

Describe how you plan to engage and involve participating sites of care and practitioners in deploying early detection programs in your healthcare system.

Character limit exceeded:

0/2100

3.2 Catalyze Change

Describe how you see the Early Detection Blueprint for Cognitive Impairment as part of your institution’s goals to improve early detection practices in your healthcare system.

Character limit exceeded:

0/3000

3.3 Additional Information (optional)

If necessary, please provide any additional information for your US Fellowship Program application.

Character limit exceeded:

0/1500

Section 4

Respondent's Declaration

Please review the declaration below that ensures your health organization meets the requirements to submit a response to this RFI.

4.1 Declarations

DAC-SP US Fellowship Program RFI Declaration by the respondent

I/we declare that in submitting this RFI response and this declaration:

If selected, the Institution will partner with DAC-SP on how to best implement the Early Detection Blueprint for Cognitive Impairment within their primary care setting
If selected, the Institution accepts the funding amount of $250,000 and will use expenses to implement the Early Detection Blueprint, attend monthly Community of Practice meetings (virtual), providing a final report by Q1 2026, and support dissemination activities
If selected, the Institution will demonstrate a sustainable impact on early detection of cognitive impairment and the dementia care pathway within the US healthcare system by contributing meaningfully to the design and dissemination of a US-focused blueprint and related initiatives as described in this RFI

By checking this box and filling out the contact information below, the respondent is agreeing to the points stated in the above declaration.

4.2 Submission

Full Name

Title/Position

Name of Institution

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Setting and Leadership Team

1.1 Healthcare System Overview

Please answer the following questions about your healthcare system

1.2 Project Leadership

Describe your clinical/leadership team who are collaborating on this US Fellowship Program and their anticipated roles in project planning and execution.

1.3 Patient Population

Describe your healthcare system’s patient population by providing an estimate of the number of patients that visited your healthcare system in 2023 across the following key demographics:

1.4 Potential for Impact

Diagnostic Care Pathways

2.1 Current Clinical Practice

2.2 Future Clinical Practice

2.3 Sustainable Activities

Implementation Early Detection in Primary Care

3.1 Program Participants

3.2 Catalyze Change

3.3 Additional Information (optional)

Respondent's Declaration

4.1 Declarations

4.2 Submission

Site Map

DAC-SP Early Detection Blueprint