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EHR-Enabled Alzheimer’s Disease Care Pathways in Primary Care: Results from a Multisite Implementation Pilot
Pai A, Huntington-Alfano K, Jain H, McAlear C, Rivet C, Forester BP.. Research Square, 2026-09-14
Topic: Health services, long-term care and technology
Background Primary care providers (PCPs) play a critical role in the early identification of Alzheimer's disease (AD), yet implementation of guideline-concordant cognitive assessment and diagnostic evaluation remains inconsistent. EHR-enabled care pathways may facilitate integration of these practices into routine primary care workflows, but real-world evidence is limited. This study evaluated the implementation of an EHR-enabled AD care pathway across three U.S. health systems. Methods This multisite pre-post implementation study was conducted to evaluate an EHR-enabled AD care pathway across three U.S. health systems. Eligible participants included primary care adult patients presenting for an Annual Wellness Visit (AWV) or adults aged ≥ 50 years presenting with memory concerns. Outcomes during the six-month post-implementation period were compared to a six-month baseline period and included cognitive assessment completion, completion of recommended laboratory evaluation, imaging and specialty referrals, and new cognitive-related diagnoses. Results A total of 10,206 eligible patients and 152 primary care providers were included across the three participating health systems. Cognitive assessment completion increased from 24.2% to 30.9%, and completion of recommended laboratory evaluation increased from 2.1% to 5.9%. Among patients who underwent cognitive assessment, the proportion with abnormal results decreased from 19.2% to 13.3%. Specialty referral rates remained unchanged, and new cognitive-related diagnoses continued to take place more frequently in specialty care settings. Conclusion Implementation of an EHR-enabled AD care pathway was associated with improved adoption of guideline-concordant cognitive assessment and recommended diagnostic evaluation in primary care across three health systems. These findings suggest that EHR-integrated tools and implementation support can facilitate evidence-based AD care within routine primary care workflows. Longer-term studies are needed to determine whether these improvements translate into earlier diagnosis and improved patient outcomes.
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APA 7th
Pai, A., Huntington-Alfano, K., Jain, H., McAlear, C., Rivet, C., & Forester, B. P. (2026). EHR-Enabled Alzheimer’s Disease Care Pathways in Primary Care: Results from a Multisite Implementation Pilot. Research Square. https://doi.org/10.21203/rs.3.rs-10767751/v1
Vancouver
Pai A, Huntington-Alfano K, Jain H, McAlear C, Rivet C, Forester BP. EHR-Enabled Alzheimer’s Disease Care Pathways in Primary Care: Results from a Multisite Implementation Pilot. Research Square. 2026. doi:10.21203/rs.3.rs-10767751/v1.
BibTeX
@article{pai2026-8b96bc40,
author = {Pai, A. and Huntington-Alfano, K. and Jain, H. and McAlear, C. and Rivet, C. and Forester, B. P.},
title = {{EHR-Enabled Alzheimer’s Disease Care Pathways in Primary Care: Results from a Multisite Implementation Pilot}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-10767751/v1},
url = {https://doi.org/10.21203/rs.3.rs-10767751/v1}
}
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Key findings
- Outcomes during the six-month post-implementation period were compared to a six-month baseline period and included cognitive assessment completion, completion of recommended laboratory evaluation, imaging and specialty referrals, and new cognitive-related diagnoses.
- Results A total of 10,206 eligible patients and 152 primary care providers were included across the three participating health systems.
- Among patients who underwent cognitive assessment, the proportion with abnormal results decreased from 19.2% to 13.3%.
- Conclusion Implementation of an EHR-enabled AD care pathway was associated with improved adoption of guideline-concordant cognitive assessment and recommended diagnostic evaluation in primary care across three health systems.
- These findings suggest that EHR-integrated tools and implementation support can facilitate evidence-based AD care within routine primary care workflows.
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Study details
- Participants10,206
- Effect size24.2% to 30.9%; 2.1% to 5.9%; 19.2% to 13.3%
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 35 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 22 of the 62 points we could judge it on, which is 35 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 4 / 4 | 10,206 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 22 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 22 of the 62 points we could judge it on is 35 out of 100. |
| Total | 35 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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