A Toolkit for Primary Care Teams

The GSA KAER Toolkit, Fall 2020 Edition, is intended to support primary care teams in implementing a comprehensive approach to initiating conversations about brain health, detecting and diagnosing dementia, and providing individuals with community-based supports. It includes practical approaches, educational resources, and validated clinical tools that teams can integrate into their workflow.

 

 

Updates to the Toolkit

October 2022 Updates

  • Added that individuals with dementia may experience dementia-related psychosis, agitation, and symptoms of pseudobulbar affect and included links to additional GSA resources regarding these issues. See pages 18 and 29.
  • Included links to brief cognitive screening tests available in languages other than English in Table A-1. See page 21.
  • Updated resources in Table E-1. Resources for the Public About Early Recognition of Dementia, Table E-4. Resources for Dementia Caused by Alzheimer's Disease, Table E-5. Resources on Dementia Caused by Vascular Conditions. See pages 27 and 31.

August 2022 Updates

  • Invited users of the KAER Toolkit to provide feedback. See page 4.
  • Showcased GSA’s Commitment to Diversity, Equity, and Inclusion and noted that, in line with this, GSA is committed to adding resources that support primary care teams to address the needs of individuals from diverse and under-served communities to the KAER Toolkit. See page 6.
  • Provided information about a comprehensive document from USAgainstAlzheimers detailing primary prevention recommendations to reduce the risk of cognitive decline, including recommended billing codes for primary care providers. See page 9.

June 2022 Updates

  • Table K-2. Resources on Brain Health for Patients was updated to include the Global Council on Brain Health’s report, "How to Sustain Brain Healthy Behaviors: Applying Lessons of Public Health and Science to Drive Change." The report addresses actions that individuals, communities, and policymakers can take to promote healthy brain behaviors is also available in Spanish, and there are infographics to promote brain health available in several languages. The report was also added to page 15.

January 2022 Updates

  • Under “Raise the topic of brain health and continue the conversation over subsequent visits” – added the USAgainstAlzheimer’s Clinician Guide on Risk Reduction, Primary Prevention Recommendations to Reduce the Risk of Cognitive Decline. See page 15.
  • Under “Listen for people’s concerns about memory and cognition” – added the USAgainstAlzheimer’s memory questionnaire, BrainGuide, that may be useful for patients who are concerned about their brain health, that of a loved one, of if they are an Alzheimer’s caregiver, it provides the tools needed to move forward confidentially. See page 16.

KAER Framework

The Toolkit is based on the KAER Framework, which consists of four steps: Kickstart, Assess, Evaluate, and Refer.

 

 

 

 

While the KAER Framework was originally developed for the primary care setting, it can be valuable to other health care professionals, educators and students.

GSA KAER in the News

July 2021: At the Alzheimer's Association International Conference, Annette L. Fitzpatrick, PhD, presented on an ongoing quality initiative at the University of Washington based on the KAER Toolkit. The aim of the initiative is to increase and improve timely detection of cognitive impairment across primary care in 15 neighborhood clinics in the Pacific Northwest. Her presentation, titled "Evaluating a System to Promote Timely Detection of Cognitive Impairment in Primary Care Practice," described the Cognition in Primary Care Program which is working on implementing an adapted version of the GSA KAER Toolkit to all 16 primary care clinics at UW Medicine.

October 2020: The Center for Disease Control and Prevention has awarded a $500,000, two-year research grant to review, refine, test, and evaluate components of the KAER Model in primary care. The recipient is Dr. Annette Fitzpatrick, Research Professor of Family Medicine at University of Washington and affiliate investigator of UW’s Health Promotion Research Center (a CDC Prevention Research Center). Dr. Fitzpatrick and her team will use the results from this study to provide recommendations for the practical application of the KAER Model and initiate steps for integrating tools into a broader reach of primary care practices within the multi-state UW Medicine network.

Other Relevant Resources

Inviting User Feedback

Please send us tools or resources that you recommend for inclusion in the kit. We also welcome input on how to enhance the KAER Toolkit from teams who have adapted the KAER Framework and used toolkit resources in their practice. Please send your feedback or suggestions to Jen Pettis at This email address is being protected from spambots. You need JavaScript enabled to view it..

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2017 KAER Toolkit: 4-Step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia

Approaches and tools for primary care providers

gsa kaer toolkitThis comprehensive toolkit is focused on the KAER model developed by the GSA Workgroup on Cognitive Impairment Detection and Earlier Diagnosis. The workgroup identified valuable tools and resources to implement the four steps in the KAER model. The resulting toolkit provides options for each of the steps so that PCPs, health plans and health care systems can select the approaches and tools that fit best with their existing primary care structure, organization, and procedures.

The toolkit is broken down by each section of the KAER model to allow quick and easy access:

  • Kickstart the cognition conversation
  • Assess for cognitive impairment
  • Evaluate for dementia
  • Refer for community resources

Each step in the model will help the PCP initiate conversations about brain health, detect and assess cognitive impairment, diagnose dementia, and provide post‐diagnostic referrals for education and supportive community services for persons with dementia and their family caregivers.

There also is a free companion webinar, "How to Use the GSA KAER Toolkit: A 4-step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia."

KAER Toolkit Table of Contents

List of Approaches and Tools Found in the Toolkit

Introduction

Additional Resources

Workgroup Members

Richard H. Fortinsky, PhD (chair)
Professor, UConn Center on Aging and Department of Medicine
Health Net, Inc. Chair in Geriatrics and Gerontology
University of Connecticut School of Medicine

Michelle Barclay
President and Co-Founder, The Barclay Group, LLC
Executive Co-Lead, ACT on Alzheimer's

Cyndy B. Cordell (ex officio)
Director, Healthcare Professional Services
Alzheimer's Association

Roderick A. Corriveau, PhD (ex officio)
Program Director, Neurodegeneration
NIH/NINDS

Nicole Barylski Danner, DO
American Osteopathic Association
Advance Neurology Associates

Fred Kobylarz MD, MPH
2013-2014 Health and Aging Policy Fellow
Associate Professor, Geriatrics
Department of Family Medicine & Community Health
Rutgers – Robert Wood Johnson Medical School

Ian N. Kremer
Executive Director
Leaders Engaged on Alzheimer's Disease

Shari M. Ling, MD
Deputy Chief Medical Officer
Center for Clinical Standards & Quality
Centers for Medicare & Medicaid Services

Natalia Loskutova, MD, PhD
Director of Evaluation, National Research Network
American Academy of Family Physicians

Katie Maslow, MSW
Scholar-in-Residence
Institute of Medicine, National Academy of Sciences

 

Lisa C. McGuire, PhD
Lead, Alzheimer’s Disease and Healthy Aging Program (AD+HAP)
National Center for Chronic Disease Prevention and Health Promotion
Division of Population Health
Applied Research and Translation Branch

Jerrold Lee Penso, MD, MBA
American Medical Group Association
Chief Medical And Quality Officer

Eleanor M. Perfetto, PhD, MS
Professor, Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland and Senior Vice President, Strategic Initiatives, National Health Council

Ronald C. Petersen PhD, MD  
American Academy of Neurology
Department of Neurology
Mayo Clinic

Mike Simmons, PhD (ex officio)
Director
Global Advocacy & Professional Relations
Eli Lilly and Company
Lilly Corporate Center

George Vradenburg
Chairman, US Against Alzheimer’s

Molly V. Wagster, PhD (ex officio)
Chief, Behavioral & Systems Neuroscience Branch
Division of Neuroscience
National Institute on Aging

Joan Weiss, PhD, RN, CRNP, FAAN
Chief, Geriatrics and Allied Health Branch
Designated Federal Official, ACICBL
Health Resources and Services Administration

 

 

lillyThis program is developed by GSA and supported by Eli Lilly and Company.