Setting

The University of Washington Physicians Neighborhood Clinics, four university-affiliated primary care clinics.

Method

Twenty-six medical assistants (MAs), who were trained in administration of the Mini-Cog, screened 524 patients aged 65 years and over and scored it after completing vital signs (noting the reason the patient was not screened, if applicable) in two primary care clinics over 12 months. They recorded the result in the electronic health record for review and further decision making by the physician. MAs were instructed not to discuss screening results with the patient and to refer any questions about the process to the patient’s physician. Scoring of the Mini-Cog by MAs was highly reliable (96% concordance with research scoring).

Results

MAs successfully screened 70% of all eligible patients who made at least one clinic visit during the intervention period; 18% screened positive. Mini-Cog screening was associated with increased dementia diagnoses, specialist referrals, and prescribing of cognitive-enhancing medications. There were no complaints about workflow interruption.