A Quality Improvement Initiative to Enhance Early Alzheimer’s Disease Detection and Diagnosis at a Southeastern Academic Medical Center
Gregory Pontone1, Rachel Reise3, Eric Rosenberg2, Chris Kriz4, Ted Singer4, Kristin Tomlinson4
1Department of Neurology, 2Internal Medicine, University of Florida College of Medicine, 3Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, 4PVI, PeerView Institute for Medical Education
Objective:
To improve early identification and diagnosis of Alzheimer’s disease (AD) by optimizing cognitive screening, referral pathways, and diagnostic readiness across primary care and neurology practices.
Background:
Although new diagnostic and therapeutic options are available, early AD recognition is often delayed by inconsistent cognitive screening, referral inefficiencies, and limited biomarker access. A quality improvement (QI) initiative was implemented to address these barriers through education, workflow redesign, and infrastructure development.
Design/Methods:
A multidisciplinary steering committee applied Plan–Do–Study–Act (PDSA) methods to establish a dedicated mild cognitive impairment (MCI) clinic, integrate an EHR-based order set with structured screening and referral fields, develop a registry and real-time dashboards, and conduct CME-accredited training for primary care clinicians (December 2024). Data from March 2024 to September 2025 were analyzed for referral volume, diagnostic testing, and confirmed AD-related diagnoses.
Results:
The average referral-to-diagnosis interval shortened to 146 days (≈5 months), reflecting a 17% improvement in timeliness. Among 3,994 neurology referrals, 669 (16.8%) were cognitive-related; 268 (40.1%) resulted in neurology visits, 115 (42.9%) included diagnostic testing, and 61 (9.1%) yielded a confirmed AD-related diagnosis (37 MCI, 5 mild dementia, 19 AD). Following the CME intervention, monthly referral volume increased by ~25%, diagnostic testing utilization rose from 17% to 22%, and cumulative confirmed diagnoses more than tripled. Biomarker tracking expanded with PET reimbursement and EHR enhancements, though pre-referral cognitive testing documentation remained modest (~15–18%).
Conclusions:
System-level QI interventions, including provider education, EHR integration, and creation of a specialized MCI clinic, improved diagnostic efficiency, biomarker readiness, and timeliness of AD diagnosis. Ongoing efforts focus on standardizing cognitive screening and scaling this model across primary care settings.
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