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Understanding Real-World Practice of Cognitive Screening and Assessment by Therapy Providers in Post-Acute Care

Rouch, Stephanie (2023) Understanding Real-World Practice of Cognitive Screening and Assessment by Therapy Providers in Post-Acute Care. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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At least 30-60% of older adults receiving post-acute care have cognitive impairments. If unaddressed, these impairments place older adults at risk of poor outcomes. Timely identification of older adults with cognitive impairments can influence patient and system outcomes. However, limited evidence exploring real-world post-acute care practices suggests there are inconsistent practices for identification of cognitive impairments. To mitigate risk of poor outcomes for this patient population, it is essential to first understand current practices and provider experiences of identifying cognitive impairments in post-acute care. Understanding current practices can inform future efforts to improve care quality and ultimately lead to positive patient outcomes.
To understand current practices, this dissertation focused on three aims. First, we examined electronic health record documentation for therapy providers in post-acute care to understand current documented practices of cognitive screening and assessment. We found evidence of cognitive screening for approximately 40 percent of older adults receiving post-acute care. Evidence of standardized assessment was observed in less than two percent of the cohort.
Second, we interviewed 18 therapy providers across post-acute care settings to explore their experiences of screening and assessing cognition, as well as what factors influenced their decision making processes. We found providers preferred to use informal observation over standardized assessments. Documentation patterns of therapy providers varied broadly across disciplines and settings due to varying documentation goals and lack of standard guidelines.
Third, we merged the quantitative and qualitative data. We found misalignment between clinical documentation and provider reports of cognitive screening, assessment, and documentation in post-acute care. All therapy providers reported consistently screening for cognitive impairments, though it was inconsistently documented in the electronic health record.
Overall, these findings provide information to inform efforts to improve care quality for older adults with cognitive impairments. Future studies should (a) examine patient, caregiver, and provider priorities of cognitive screening and assessment, (b) include patients from diverse geographic regions and social backgrounds in quantitative and qualitative studies, and (c) explore the relationship between documentation of cognitive screening and assessment with stakeholder prioritized outcomes. These efforts can ultimately improve care quality and outcomes for older adults with cognitive impairments.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Rouch, Stephaniesar148@pitt.edusar1480000-0002-0601-2462
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairLeland, Natalie Enel24@pitt.edunel240000-0002-0329-3772
Committee MemberSkidmore, Elizabeth Rskidmore@pitt.eduskidmore0000-0002-8287-7193
Committee MemberRodakowski, Juleenjur17@pitt.edujur170000-0002-6397-8124
Committee MemberTerhorst, Laurenlat15@pitt.edulat150000-0002-2326-8005
Committee MemberGary-Webb, Tiffanytgary@pitt.edutgary0000-0001-9843-1084
Date: 30 January 2023
Date Type: Publication
Defense Date: 15 November 2022
Approval Date: 30 January 2023
Submission Date: 18 October 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 104
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cognition, quality of care, health equity, post-acute care, mixed methods
Additional Information: One chapter has been accepted for publication in JAMDA (Chapter 2) and includes a statement that the publisher has granted permission for re-printing this article in the dissertation.
Date Deposited: 30 Jan 2023 17:32
Last Modified: 30 Jan 2023 17:32


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