Factors Associated with Clinician Adherence to Clinical Practice Guidelines for the Diagnosis of Alzheimer’s Dementia (P6.194)

Objective: We wanted to determine what factors affect clinician adherence to Alzheimer’s disease (AD) diagnostic guidelines. Background: In February 2001, the American Academy of Neurology (AAN) released practice parameters for the diagnosis of AD; in 2011, a workgroup of the National Institute of Aging and Alzheimer’s Association also published guidelines for diagnosing AD. Design/Methods: Data on patients diagnosed with AD from September 2013 to June 2016 were extracted from the electronic medical record (EMR) at an academic medical center. We collected demographic and clinician-specific variables. Assessment variables recommended as necessary for diagnosis and those that were labeled as unnecessary in the guidelines, were recorded as dichotomous variables indicating presence or absence. We then categorized patients into “diagnosed in accordance to guidelines” and “not diagnosed in accordance to guidelines.” Odds ratios and 95% confidence intervals and a t-test were used for comparisons. A logistic regression model was created to determine the effect of specialty of diagnosing physician on adherence to guidelines. All statistical analyses were performed in SPSS. Results: Of the 101 patients included in the study, 51 (50.5%) were diagnosed in accordance to guidelines and 50 (49.5%) were not. Patients diagnosed by a Neurologist or a Geriatricians were 2.98 times as likely to have been diagnosed in accordance to guidelines as those who were diagnosed by less specialized physicians, after adjusting for clinical setting of diagnosis and level of physician training, and after stratifying by language spoken by the patient (OR 2.98 95% CI 1.3–6.9, p = 0.01). Conclusions: Physicians more specialized in caring for elderly patients or in caring for cognitive disorders are more likely to diagnose AD patients in accordance to published guidelines. More quality improvement studies should be conducted to study the broader pattern of adherence. Physicians and residents of other specialties should be made aware of this gap in diagnostic care. Disclosure: Dr. Malik has nothing to disclose. Dr. Cibula has nothing to disclose. Dr. Morley has nothing to disclose. Dr. Sanders has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Dr. Sanders received compensation for disability file review consultations for PsyBar, Dane Street, Professional Disability Associates, and Academic Insurance.