Bringing memory clinic to a federally qualified health center (FQHC)

5 5 million Americans have dementia, a growing number as the population ages The wait time for specialist referral averages in months which adds to the societal, economic, and caregiver impact A portion of this impact can be mitigated by early identification of neurocognitive deficits in the primary care setting We established a weekly cognitive assessment clinic at our FQHC led by 2 geriatricians The clinic caters to patients aged 55 years and above (36% of IM/FM patients) with a special focus on the immigrant population and those with language or other social barriers in order to improve access to dementia care for underserved patients Phase I of the setup was planning and training requiring 5 hours (1 session) per week for 3 months (Oct-Dec 2020) We shadowed at an academic memory clinic to learn about the workflow and memory testing tools We established a liaison with the Alzheimer's Association We trained 2 medical assistants, 2 Vietnamese interpreters, and 1 Spanish interpreter The providers and interpreters acquired MOCA certification A registry created using pertinent ICD10 codes was shared with colleagues for referrals Phase II: implementation (Jan 2021-Aug 2021) was modified in light of the Covid-19 pandemic The memory clinic format consists of 2-3 visits;a telemedicine visit for history, an office visit for in-person memory testing and physical exam, and a 3rd visit to discuss results and treatment plan if warranted The memory clinic is set up with 1 session per week alternating between two providers There are six 30-minutes appointments per session Phase I and the MOCA certification was the primary cost of setting up the clinic funded by the Massachusetts League of Community Health Centers 76 patients (48 females and 28 males) were selected from 256 patients in the primary registry Among them, 70% were non-English speaking (42 Vietnamese, 6 Spanish, 6 other) Most patients had income status below 200% of the federal poverty level and many were immigrants We were able to recruit more vulnerable and non-English speaking patients for our clinic Certified interpreters can administer memory testing in patients' preferred language to better support our immigrant population Our clinic improves access to dementia care and reduces long referral times As an FQHC, there is no substantial difference between reimbursement rates for higher complexity codes, and seeing 6 patients per session may decrease revenue which can be a limitation of this clinic