Express Dementia Care in East Texas (EDCC): An Integrated, Closed-loop Model to Shorten Time-to-diagnosis and Improve Caregiver Outcomes
Khushboo Verma1, Haylee Voyles1, Elisabeth Burnett1, Satwant Kumar4, Andrea Gohmert2, Andrew Schmitt3
1Dementia Center, 2Rehabilitation Sciences, 3Medicine, University of Texas at Tyler, 4NeuroReef Labs
Objective:
To implement and evaluate a multidisciplinary “Express Dementia Care” pathway that (1) optimizes referrals with closed-loop PCP–specialist communication, (2) uses the wait period for structured assessment and lifestyle initiation, and (3) delivers a definitive diagnosis and written plan within a fixed time window, refined through Plan-Do-Study-Act (PDSA) cycles.
Background:
Rural patients face prolonged waits for specialty dementia care and fragmented services, amplifying caregiver burden and delaying timely intervention. East Texas lacks an integrated pathway that links primary-care, rapid pre-visit workup, and definitive behavioral neurology assessment within a single, coordinated model.
Design/Methods:

Prospective implementation at UT Health North Campus, Tyler. The pathway comprises:

  1. Referral optimization: standardized completeness metrics, feedback to PCPs, and specialty-visit targets from referral (T0): ≤8 weeks (Year 1), ≤6 weeks (Year 2).

  2. Integrated pre-visit (≤2–3 weeks from T0): demographics and SDOH; cognitive screens (MoCA/MMSE, SMCQ, FAQ); mood (PHQ-4 ± PHQ-9/GAD-7); sleep (ISI-7, STOP-Bang); therapy needs (PT/OT/SLP/audiology); caregiver burden (ZBI-8); goal setting/barriers; immediate lifestyle counseling and referrals.

  3. Behavioral neurology visit: complete diagnostic workup (serum labs, MRI, neuropsychology) and, when appropriate, biomarker-guided anti-amyloid eligibility counseling (PET amyloid/APOE).

All data are captured in REDCap; PDSA microcycles occur every 6 months with run/control charts. Pre-specified success thresholds (Months 0–24): ≥90% pathway completion ≤8 weeks, mean referral completeness ≥4.5/5, ≥3-point ZBI-8 reduction, ≥85% SDOH linkage, and Net Promoter Score ≥ +50.

Results:
We will report feasibility, fidelity to time targets, changes in referral completeness, caregiver burden, SDOH linkage rates, patient-reported outcomes, and stakeholder experience. Iterative PDSA changes (e.g., EMR hard-stops, dedicated MRI blocks, navigator scripting) will be described with pre/post process-control analyses.
Conclusions:
EDCC operationalizes a practical, exportable pathway for rural dementia care by compressing time-to-diagnosis, activating lifestyle and support services during the wait, and embedding continuous QI. If benchmarks are achieved, we will disseminate a living implementation toolkit to enable multisite replication across similar underserved regions.
10.1212/WNL.0000000000215423
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.