One Size Does Not Fit All: Choosing Practical Cognitive Screening Tools for Your Practice

Every year, millions of patients worldwide undergo cognitive testing. Unfortunately, new barriers to the use of free open access cognitive screening tools have arisen over time, making accessibility of tools unstable. This article is in follow-up to an editorial discussing alternative cognitive screening tools for those who cannot afford the costs of the Mini-Mental State Examination and Montreal Cognitive Assessment (see www.dementiascreen.ca ). The current article outlines an emerging disruptive “free-to-fee” cycle where free open access cognitive screening tools are integrated into clinical practice and guidelines, where fees are then levied for the use of the tools, resulting in clinicians moving on to other tools. This article provides recommendations on means to break this cycle, including the development of tool kits of valid cognitive screening tools that authors have contracted not to charge for (i.e., have agreed to keep free open access). The PRACTICAL.1 Criteria ( PRACTI cing C linician A ccessibility and L ogistical Criteria Version 1 ) are introduced to help clinicians select from validated cognitive screening tools, considering barriers and facilitators, such as whether the cognitive screening tools are easy to score and free of cost. It is suggested that future systematic reviews embed the PRACTICAL.1 criteria, or refined future versions, as part of the standard of review. Methodological issues, the need for open access training to insure proper use of cognitive screening tools, and the need to anticipate growing ethnolinguistic diversity by developing tools that are less sensitive to educational, cultural, and linguistic bias are discussed in this opinion piece. J Am Geriatr Soc 68:2207–2213, 2020.     

How do you implement value-based care methodologies in dentistry with existing dental organizational paradigms?

The U.S. healthcare sector is a paradox – achieving comparatively poor population health outcomes despite outspending the world – and the current paradigm is a dichotomy – pursuing value definition consisting of quality, outcome, and cost, but failing to act in aligned and informed manner. In 2018, U.S. dental spending was $136 billion, accounting for 3.7 percent of total healthcare spending, a relatively nominal amount when considering oral diseases are among the most prevalent and have serious health and economic burdens, greatly reducing quality of life for those affected. Consistent and growing evidence shows that primary care-oriented systems achieve better health outcomes, more health equity, and lower costs; however, to date, there is little means to structuralize the role of oral health and quantify the value provided. To understand the reasons behind the abstract nature of value-based care requires an in-depth understanding of the drivers impeding the transition to a value based oral health system of care. One large clinically integrated network will provide detail of their experience.