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BACKGROUND AND PURPOSE: To describe student pharmacist's application of the Pharmacists' Patient Care Process (PPCP) during participation in an interprofessional introductory pharmacy practice experience (IPPE) at a Type 1 Diabetes (T1D) pediatric summer camp. EDUCATIONAL ACTIVITY AND SETTING: Student pharmacists entering professional year two (P2) and three (P3) attended a one-week, overnight T1D summer camp as part of the longitudinal IPPE curriculum between June 2021 and July 2023. They completed two PPCP assignments, a reflective assignment and a self-evaluation following the experience. FINDINGS: Thirty-seven students attended camp. The most common PPCP assignments submitted corresponded to the collaborate core competency (75.6%) and the implement (51.4%) and collect (27.0%) steps. Written reflections revealed students learned about therapeutic monitoring of diabetes, hypoglycemia and hyperglycemia management, insulin dose adjustment, and lifestyle strategies such as carbohydrate counting. Many students expressed feeling increased empathy (59.5%) and inspiration (56.8%) toward individuals with T1D. Students reflected positively on their experience working with an interprofessional team. Self-evaluations indicated perceived competency in all steps and core areas of the PPCP, especially in communication. DISCUSSION: Overall, student feedback indicates inclusion of camp as a non-traditional pharmacy practice site provides ample opportunity to apply the PPCP through participation and interprofessional decision-making opportunities in patient care. Our findings demonstrate camp provided the ability to partake in activities that encompass every step and core component of the PPCP. Immersion in the camp environment allowed early learners to feel competent in their ability to engage in the PPCP and communicate with patients and healthcare professionals. SUMMARY: Participation in a T1D summer camp provided early student pharmacists exposure to direct patient care and opportunity to apply the PPCP in an interprofessional education environment. Students learned clinical diabetes knowledge and skills, in addition to increased empathy and a feeling of inspiration. Students felt highly competent in their ability to communicate with patients, pharmacists, and other healthcare providers.

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Background: Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis. It is important to identify predictors of excellent outcomes (good clinical outcomes, more time spent at home) after TAVR that are potentially amenable to improvement. Objectives: The purpose of the study was to use machine learning to identify potentially modifiable predictors of clinically relevant patient-centered outcomes after TAVR. Methods: We used data from 8,332 TAVR cases (January 2016-December 2021) from 21 hospitals to train random forest models with 57 patient characteristics (demographics, comorbidities, surgical risk score, lab values, health status scores) and care process parameters to predict the end point, a composite of parameters that designated an excellent outcome and included no major complications (in-hospital or at 30 days), post-TAVR length of stay of 1 day or less, discharge to home, no readmission, and alive at 30 days. We used recursive feature elimination with cross-validation and Shapley Additive Explanation feature importance to identify parameters with the highest predictive values. Results: The final random forest model retained 29 predictors (15 patient characteristics and 14 care process components); the area under the curve, sensitivity, and specificity were 0.77, 0.67, and 0.73, respectively. Four potentially modifiable predictors with relatively high Shapley Additive Explanation values were identified: type of anesthesia, direct movement to stepdown unit post-TAVR, time between catheterization and TAVR, and preprocedural length of stay. Conclusions: This study identified four potentially modifiable predictors of excellent outcome after TAVR, suggesting that machine learning combined with hospital-level data can inform modifiable components of care, which could support better delivery of care for patients undergoing TAVR.

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Background: The prevalence and incidence of cardiovascular diseases significantly increase with age, and it is well-known that nutritional status affects the prognosis and treatment of these diseases. Therefore, evaluating nutritional status is essential for maintaining/regaining health. It is crucial to identify nutritional risk early, prevent and/or treat protein-energy malnutrition, and promote the modification of inappropriate dietary habits. Methods: Nutritional screening represents the first step of access to the Nutrition Care Process (NCP) adopted and managed by the dietitian; this tool must be simple, inexpensive, accessible, accurate, efficient, and validated. A globally accepted standardized definition of malnutrition is necessary, and for this reason, the Global Leadership Initiative on Malnutrition (GLIM) criteria have been recently introduced.The GLIM criteria, after confirming nutritional risk through screening, include both phenotypic and etiological criteria: to diagnose malnutrition, at least one of these must be present.A less commonly performed phenotypic criterion is the assessment of muscle mass, which should be studied as a significant component of sarcopenia. Conclusion: Greater attention to the identification and treatment of malnutrition would bring benefits to patients and ensure a saving in healthcare expenditure, but for this purpose, an implementation of clinical nutrition services is necessary.

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For artificial intelligence (AI) to support nutrition care, high quality and accuracy of its features within smartphone applications (apps) are essential. This study evaluated popular apps' features, quality, behaviour change potential, and comparative validity of dietary assessment via manual logging and AI. The top 200 free and paid nutrition-related apps from Australia's Apple App and Google Play stores were screened (n = 800). Apps were assessed using MARS (quality) and ABACUS (behaviour change potential). Nutritional outputs from manual food logging and AI-enabled food-image recognition apps were compared with food records for Western, Asian, and Recommended diets. Among 18 apps, Noom scored highest on MARS (mean = 4.44) and ABACUS (21/21). From 16 manual food-logging apps, energy was overestimated for Western (mean: 1040 kJ) but underestimated for Asian (mean: -1520 kJ) diets. MyFitnessPal and Fastic had the highest accuracy (97% and 92%, respectively) out of seven AI-enabled food image recognition apps. Apps with more AI integration demonstrated better functionality, but automatic energy estimations from AI-enabled food image recognition were inaccurate. To enhance the integration of apps into nutrition care, collaborating with dietitians is essential for improving their credibility and comparative validity by expanding food databases. Moreover, training AI models are needed to improve AI-enabled food recognition, especially for mixed dishes and culturally diverse foods.

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BACKGROUND AND OBJECTIVES: Study aim was to determine the levels and barriers of the Nutrition Care Process (NCP), a practical method of individualized nutrition support. METHODS AND STUDY DESIGN: Delegate of registered dietitians (RDs) from acute-care hospitals answered our nationwide web-based questionnaire (April-June, 2023) to determine the implementation status of screening, assessment, intervention (including planning), and monitoring (components of the NCP). RESULTS: Of 5,378 institutions contacted, 905 (16.8%) responded. For Screening, 80.0% screened all inpatients: primary personnel in charge were RDs (57.6%); the most used screening tool was Subjective Global Assessment (SGA) (49.2%). For Assessment, 66.1% assessed all inpatients: food intake (93.3%) was most evaluated whereas muscle mass and strength (13.0%, 8.8%) were least evaluated. For Intervention, 43.9% did so within 48h of hospital admission: oral nutritional supplement (92.9%) was the most common RDs intervention and parenteral nutrition (29.9%) was used less. For Monitoring, 18.5% of institutions had monitoring frequency of ≥ 3 times/week whilst 23.0% had monitoring less than once a week for severely malnourished patients. Energy and protein intake (93.7%, 84.3%) were most monitored and lipid intake (30.1%) was less monitored. CONCLUSIONS: Barriers of NCP included inefficient staffing systems and unsuitable tools in Screening, inaccurate patient targeting and lack of important evaluation items in Assessment, delayed timing and incomplete contents in Intervention, and inadequate fre-quency and lack of important evaluation items in Monitoring. An increase in RDs staffing in acute-care general wards, widespread NCP instruction manuals, and education about the tools and evaluation items utilized in nutritional management are possible solutions.

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AIM: Cardiorespiratory events in preterm infants pose a major challenge in the Neonatal Intensive Care Unit as they require a prompt response. We aimed to describe caregivers' responses to these events. METHODS: We performed a prospective observational study in 19 preterm infants (28 ± 2 weeks) on non-invasive respiratory support using video recordings of the inside of the incubator for 72 (55-72) h. Caregivers' responses to these events were then identified from the videos. RESULTS: We recorded and assessed 1851 cardiorespiratory events with a median duration of 11.0 (5.0-23.0) s. No response was observed in the majority of the events (91.5%). In the remaining 8.5% events, caregivers responded by pausing the alarm, adjusting devices and/or providing tactile stimulation with an average response time of 25.4 (13.8-35.9) s. Stimulation was the most observed response and was applied in 38 different ways. On average, stimulation lasted 18.7 (11.6-44.6) s and the cardiorespiratory events were resolved 30.6 (19.5-47.6) s after stimulation started. CONCLUSION: Our study showed that cardiorespiratory events are common in preterm infants in the NICU, but often not followed by intervention of the caregiver. The indication, timing and execution of responses to cardiorespiratory events is highly variable.

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Background and Objective: The Nutrition Care Process (NCP) is a systematic method used by dietitians to provide high-quality nutrition care resulting in good patient outcomes. This study aimed to assess the NCP implementation and use of NCP Terminologies (NCPT) among hospital dietitians in the Philippines. Specifically, the study aimed at assessing the knowledge, perception, and practices on NCP and use of NCPT and correlate them with the dietitians' education, and professional and employment profile; and explain the barriers and facilitators of the practice of NCP and use of NCPT among hospital dietitians in the Philippines. Methods: The knowledge, perception, and practices (KPP) on NCP and NCPT of the dietitians employed in the Philippine Department of Health's licensed level 3 hospitals were determined using a validated questionnaire. Significant factors associated with the KPP were also determined. The barriers and facilitators of the practice of NCP and NCPT were determined using focus group discussion and key informant interviews of chief clinical dietitians and hospital administrators, respectively. Results: The study revealed that majority of the participants had a high level of knowledge on NCP and NCPT, positively perceived its implementation, and more than half of them implement NCP and NCPT in the hospitals. The participants' knowledge on NCP and NCPT was significantly associated with research involvement and active membership in a professional organization. While the practice of NCP and NCPT was significantly associated with having NCP-related trainings, frequency of trainings, and active membership in a professional organization. The barriers to NCP implementation were insufficient resources; lack of orientation, trainings, and support; organizational and administrative constraints; pandemic constraints; insufficient time; and lack of confidence to conduct NCP. While the facilitators of implementation were collaboration, dedication, and commitment of the healthcare team; institutionalization of NCP laws and policies; budget allocation for NCP-related activities; monitoring and consistency of NCP implementation; and work schedule. Conclusion: The findings suggest that the implementation of NCP and NCPT in the Philippines needs further support from the institution, professional organizations, and policy makers by developing strategies to cope with the barriers, and strengthen the facilitators and factors associated with practice.

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BACKGROUND AND PURPOSE: The objective of this project was to assess the impact of self-care scenario simulations on first year doctor of pharmacy student performance and self-perceived confidence in applying the Pharmacists' Patient Care Process (PPCP) during self-care encounters. EDUCATIONAL ACTIVITY AND SETTINGS: Self-care scenarios were developed and used during low fidelity simulations in laboratory sessions in a skills-based course. Students met individually with faculty facilitators role-playing patients to apply the PPCP in four simulations. Facilitators graded student performance; a comparison was made between performance on the first and fourth simulation. Students completed a pre- and post-course survey regarding their self-perceived confidence in performance and knowledge in applying the PPCP in self-care encounters. FINDINGS: One hundred and eight (100%) of enrolled students voluntarily agreed to participate in this IRB-approved study. The median percentage of student scores on the fourth simulation, 90.7%, was higher compared to the median percentage of student scores on the first simulation, 82.4%, P < 0.001 with a raw difference of 8.3 percentage points, for participants with scores for both simulations, 106 (98%). For the self-perceived PPCP confidence survey, 100 (92.5%) participants completed both pre- and post-course surveys. Self-perceived confidence on 12 of the 15 survey items where students ranked their confidence in performance and knowledge in self-care encounters increased post- versus pre-course. SUMMARY: Simulations served as a useful tool in improving student performance in applying the PPCP in self-care encounters in a first year doctor of pharmacy course. Student self-perceived confidence in performance and knowledge in self-care encounters also increased.

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BACKGROUND: Food as medicine (FAM) interventions have been associated with improved health outcomes. However, there is limited FAM evidence in food retail settings. OBJECTIVE: The objective was to evaluate the feasibility of a registered dietitian nutritionist-led FAM program that aims to detect changes in participants' nutrition problems and related nutrition and health outcomes, as documented by the Nutrition Care Process framework. DESIGN: The study was a descriptive feasibility nutrition intervention cohort analysis. PARTICIPANTS SETTING: A convenience sample of online food shoppers were enrolled in collaboration with a food retail chain (n = 39 participants completed the intervention and were included in primary analyses). INTERVENTION: Participants received nutrition care for 6 months either in person or via telehealth. The FAM intervention included tailored nutrition care that integrated software-generated meal plans and food shopping lists to support online food shopping. MAIN OUTCOME MEASURES: Progress of nutrition problems and diet quality (assessed via the Picture your Plate survey) were measured. Measurements included changes in anthropometric and biochemical parameters, blood pressure, and quality of life (assessed via the Centers for Disease Control and Prevention's Health Related Quality of Life-14 survey). STATISTICAL ANALYSES PERFORMED: Mann-Whitney U test, Pearson's χ2, and Wilcoxon signed-rank tests were used to detect differences. RESULTS: The most prevalent nutrition problems demonstrated improvement rates as follows: excessive energy intake, 81% (n = 21 of 26); excessive carbohydrate intake, 88% (n = 7 of 8); and obesity, 100% (n = 5 of 5). Exposure to the FAM intervention improved dietary quality, quality of life, body weight, waist circumference, and systolic pressure. CONCLUSIONS: FAM interventions can be carried out by in-store registered dietitian nutritionists in the supermarket setting. This feasibility study highlighted the need and opportunity for larger studies in which registered dietitian nutritionist-led FAM interventions, in collaboration with food retailers, may improve people's nutrition and health.

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OBJECTIVE: Given the importance of developing student understanding and application of the Pharmacists' Patient Care Process (PPCP), programs may be able to use successful approaches from other institutions to enhance their curricular and experiential learning and assessment of student outcomes. The study objective was to explore successful methods of integrating the PPCP and outline areas of challenge. METHODS: This study used a qualitative study design with semistructured interviews to gain insight from participants' lived experiences. Pharmacy faculty members participating in a national survey or who were authors of articles about PPCP initiatives were recruited to provide greater detail about building successful and innovative curricula. Thematic analysis identified commonalities and differences among the interviewed participants. RESULTS: A total of 10 interviews were conducted. The following 4 overarching themes arose from the data: discussions around intentional integration of the PPCP across multiple core courses may foster innovations in teaching strategies; intentional integration alone does not equate to PPCP integration across the curriculum; intentional integration may enhance program assessment; and PPCP data from experiential coursework may not be widely used in curricular continuous quality improvement. CONCLUSION: Pharmacy programs will ideally involve the entire faculty, including experiential and basic and social/administrative science members, in weaving the PPCP throughout the curriculum. Rigorous assessment can better inform interventions related to student competency in various steps of the PPCP. Pharmacy programs should also clarify how data obtained from preceptors observing student performance in each of the PPCP steps are used to assess student mastery of this critical skill.

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The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.

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The level of NCP implementation varies across countries due to differences identified in major components of health systems such as infrastructures, legislation, training, and cultural diversities. Dietitians in Greece receive sufficient training in the implementation of the NCP as part of their main studies; however, the level of awareness and adoption of the NCP model is still quite low, with limited information on the potential barriers. The primary aim of this study was to gain a deeper understanding of the perspectives of Greek dietitians on the NCP and the use of digital tools. An online survey was created and distributed through the platform "SurveyMonkey version 4.1.1". The overall structure of the questionnaire was modeled according to the validated NCP/NCPT INIS Tool. A total of 279 subjects were included in this study, and 192 were aware of the NCP tool. The most important challenges for the implementation of the NCP included communication with other healthcare professionals (68.2%), provision of appropriate care (33.9%), and insufficient access to continuous education (29.2%). Of the 192 participants who knew the NCP, 81.3% reported using digital applications for the collection and assessment of health data, while 18.8% indicated that they did not utilize such tools. No relationship was found between the use of digital applications by dietitians, NCP knowledge, and demographic characteristics. Our findings highlight the need for targeted educational interventions and appropriate application of standardized protocols by Greek dietitians in daily practice. National Dietetic Associations should provide sufficient guidance on digital tool utilization in facilitating patient data management and enhancing NCP implementation.

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PURPOSE: Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. METHODS: This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. RESULTS: A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). CONCLUSION: The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

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In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

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The Medical and Pharmacy Student Collaboration (MAPSC) student organization at the University of Southern California, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, created an extracurricular, peer-led, virtual group mock objective structured clinical examination (MOSCE) to expose first-year pharmacy students (P1s) to the Pharmacists' Patient Care Process (PPCP). The purpose of this study is to evaluate the impact of a MAPSC MOSCE on P1s self-reported confidence in applying the PPCP and on patient communication, medication knowledge, and clinical skills. An anonymous, optional, self-reported survey was administered to P1s before and after the event, where they rated their confidence on a scale of 0-100 (0 = not confident, 100 = certainly confident). The statistical analysis was a paired two-tailed t-test with a significance level of p < 0.05. A total of 152 P1s and 30 facilitators attended the MOSCE. One hundred thirty-nine students met the inclusion criteria and were included in the data analysis. There was a statistically significant difference in the change in self-reported confidence for all PPCP components and learning outcomes. The results of our study strongly indicate that introducing P1 students to the PPCP through a MAPSC MOSCE format is a valuable experience.

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Since the incorporation of the Pharmacist's Patient Care Process (PPCP) into the American Association of Colleges of Pharmacy standards, the process has been integrated in a variety of ways across curriculums. A two-semester case-based course was redesigned as a four-semester case-based course formally integrating the PPCP. Pharmacy students completing the original, two-semester course series and those completing the first two semesters of the redesigned course were given a voluntary survey to assess their perceived ability to integrate the PPCP into practice after the completion of each course. A total of 107 pharmacy students, 61 students completing the original series and 46 students completing two semesters of the redesigned series, completed the survey. The pharmacy students completing the redesigned, four-semester course series had a significantly higher perception of their ability to integrate the PPCP into patient care compared to the students completing the original series. This included the perceived ability to ask appropriate questions, identify medication-related problems (MRPs), document MRPs, and develop a plan for addressing MRPs. A significant difference was found in the students' perceived ability to ask pertinent questions in an appropriate manner, identifying and documenting MRPs, managing and solving MRPs, and documenting patient interactions. No significant difference was identified regarding the students' perceived ability to document the interaction or ensure that treatment-related plans were implemented. The students' perception regarding the importance of asking pertinent questions, identifying MRPs, and documentation in patient care did not differ between the cohorts. The case-based course series redesigned from two to four semesters with formal integration of the PPCP resulted in an increase in the students' perceptions of their ability to integrate the PPCP into patient care.

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OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

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Introduction Quality indicators (QIs) are essential for adequate control of the health care management process, recognizing areas of improvement and providing solutions. We aimed to evaluate the Integrated Breast Cancer (BC) Care Process QIs. Methods We studied 487 consecutive BC cases diagnosed from November 1st, 2013, to November 30th, 2019, in a Spanish healthcare area, and we estimated the associated QIs. Results Four indicators did not meet the standards and were analysed based on related sociodemographic and clinical variables. The surgical delay after a multidisciplinary team discussion (mean 64%, IQR 59.6–68.5) was lower in elder people (p=0.027), and early histological grades (p=0.019) and stages (p=0.008). The adjuvant treatment delay (mean 55.7%, IQR 51.1–60.3) was lower in advance stages (p=0.002) and when there was no reoperation (p=0.001). The surgical delay after inclusion (mean 83.2%, IQR 79.3–87.2) was lower in early histological grades (p=0.048). The immediate reconstruction (mean 42.3%, IQR 34.0–50.5) reached 72.3% in young women compared to 11.8% in older than 70 years (p=0.001) and it was higher in early stages (45.3% vs 36.2%; p=0.049). Conclusion The study of QIs evaluated their compliance and analysed the variables influencing them to propose improvement measures. Not all the indicators were equally valuable. Some depended on the available resources, and others on the mix of patients or complementary treatments. It would be essential to identify the specific target populations to estimate the indicators or provide standards stratified by the related variables (AU)

Introducción Los indicadores de calidad (IC) son esenciales para el adecuado control del proceso asistencial en el sistema sanitario, permitiendo el reconocimiento de áreas de mejora y proporcionando soluciones. Nuestro propósito ha sido evaluar los IC en el proceso asistencial integrado cáncer de mama (CM). Métodos Se estudiaron 487 casos consecutivos de CM diagnosticados desde noviembre de 2013 hasta 2019 en un área sanitaria de España y se estimaron los IC asociados. Resultados Cuatro indicadores no cumplieron los estándares de calidad y fueron analizados en función de las variables sociodemográficas posiblemente relacionadas. El retraso quirúrgico tras el comité multidisciplinar (media 64%, rango intercuartílico [IQR] 59,6-68,5) fue menor en pacientes más mayores (p=0,027), y en grados histológicos (p=0,019) y estadios (p=0,008) más tempranos. El retraso en el tratamiento adyuvante (media 55,7%, IQR 51,1-60,3) fue menor en estadios más avanzados (p=0,002) y cuando no hubo necesidad de rescisión (p=0,001). El retraso quirúrgico tras la inclusión en lista de espera (media 83,2%, IQR 79,3-87,2) fue menor en grados histológicos más tempranos (p=0,048). La reconstrucción inmediata (media 42,3%, IQR 34,0-50,5) se realizó en un 72,3% de las mujeres jóvenes comparado con tan solo un 11,8% de las mayores de 70 años (p=0,001) y fue mayor en estadios tempranos (45,3% vs. 36,2%; p=0,049). Conclusión El estudio de los IC evaluó su cumplimiento y analizó las variables que los influencian para proponer medidas que los mejoren. No todos los indicadores pudieron evaluarse de igual forma. Algunos dependieron de los recursos disponibles, otros del tipo de paciente y otros de los tratamientos complementarios. Sería necesario identificar las poblaciones diana para estimar los IC más adecuados o proporcionar estándares estratificados por las variables relacionadas (AU)

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BACKGROUND: We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS: We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS: Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS: Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS: Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.

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