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The Montreal Cognitive Test Intervention: The Relationship Between Cognitive-Impaired Patients and Readmissions
1Andrew Kim, PhD, MPH, is Assistant Professor, the Master of Public Health Program at Central Michigan University. Andrew Kim's current research focuses on health policy, health economics, and healthcare reform. Before coming to Central Michigan University, Andrew was a visiting faculty at the University of South Florida where he taught courses in health policy and healthcare management. Before going into academia, Andrew was a hospital administrator in Champaign, IL. He holds a PhD in Health Policy and Management, Master in Public Health, Bachelor of Science in Psychology, and Bachelor of Science in Community Health at the University of Illinois at Urbana Champaign.
Insights
Cognitive impairment is common in Medicare patients and linked to hospital readmissions. Early detection using the Montreal Cognitive Assessment (MoCA) can help reduce readmission risks and associated costs.
Area of Science:
- Healthcare Management
- Geriatric Medicine
- Health Economics
Background:
- The Affordable Care Act (ACA) introduced the Hospital Readmission Reduction Program, impacting hospital reimbursements for Medicare readmissions within 30 days.
- Limited research has explored the economic implications of cognitive impairment in Medicare patients concerning hospital readmissions.
Purpose of the Study:
- To investigate the relationship between cognitive impairment in Medicare patients and hospital readmissions.
- To assess the prevalence of cognitive impairment among Medicare patients experiencing readmissions.
- To evaluate the utility of the Montreal Cognitive Assessment (MoCA) for quality improvement in detecting cognitive impairment.
Main Methods:
- An ethnographic approach with purposive sampling was employed.
- A nonrandomized, purposive sampling intervention study utilized data from the Epic health systems database.
- The study involved a 3-phase, 5-month intervention using the MoCA in a hospital setting.
Main Results:
- Cognitive impairment is prevalent in the Medicare population, with 61% of patients scoring below 25 on the MoCA.
- The mean MoCA score for patients with cognitive impairment was 17.84 (SD, ±5.06).
- The MoCA demonstrated utility in identifying acute care patients at increased risk for readmission.
Conclusions:
- The ACA promotes patient-centered care, emphasizing quality metrics and holistic care approaches.
- Effective case management and innovative patient evaluation methods are crucial for hospitals.
- Further randomized controlled trials are warranted to validate the association between cognitive impairment and readmissions.
Background:
The purpose of this study is to determine whether there is a relationship between cognitive impairment among Medicare patients and hospital readmissions. Although there has been research on cognitive impairment and readmissions, seldom action has been done in regard to economic costs with hospitals. The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program in 2012. Hospitals may not be fully reimbursed for Medicare patient readmissions within 30 days ().
Study Design:
An ethnographic approach was utilized with purposive sampling.This was a nonrandomized purposive sampling intervention study using data from Epic health systems database.
Methods:
The intervention spanned over 5 months and the MoCA (Montreal Cognitive Assessment) intervention was conducted in the hospital in a 3-phase study. The purpose of the study was for quality improvement and to detect cognitive impairment among Medicare readmitted patients.
Results:
The result shows cognitive impairment is prevalent among the Medicare population. Seventy-one (61%) had evidence of cognitive impairment (i.e., obtained a score below 25). The mean MoCA score for the 71 patients identified as having evidence of cognitive impairment was 17.84 (SD, ±5.06; range, 5-24). MoCA is useful in the acute care setting for identifying patients who are at increased risk for readmission. A randomly assigned controlled clinical trial test is warranted to further validate the association between cognitive impairment and readmissions.
Implications For Case Management:
The ACA aims to improve case management by improving effective outcomes for individuals, care coordination among hospital professionals, economic efficiency, cost-effectiveness, and the collaborative process that services the patient. Hospitals across the country are implementing polices that adhere to patient-centered care. Before the ACA was passed, health care services were value metric. The ACA regulates hospitals toward holistic care or quality metrics. Case management will be critical, as hospitals look toward innovative methods to evaluate their patients.
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