Date of Completion


Document Type

Open Access Capstone

Degree Name

Doctor of Nursing Practice (DNP)

Faculty Advisor

Priscilla Gazarian, PhD, CNS, RN

Site Advisor

Alyssa DeConto, WHNP, CNM

Second Reader

Janice Foust, PhD, RN


BACKGROUND: There are six million people with dementia living in the United States and this number is expected to rise exponentially due to the aging population. In the United States, it is estimated that only two thirds of dementia cases are recorded during primary care visits and an estimated, one third of cases have been either missed or disregarded.

LOCAL PROBLEM: In a remote primary care clinic on Kodiak Island, off the southeastern coast of Alaska, there is a lack of dementia and related cognitive diagnoses in the primary care setting due to patients’ and families lack access to the healthcare system and information related to the disease process. Primary care clinicians, healthcare entities, caregivers and patients are presented with unique challenges due to geographical location. In this setting, as with many other rural settings across the country, there are significant numbers of delayed or under detected diagnosis of dementias and cognitive concerns due to lack of resources and provider confidence in managing dementia centered care.

PURPOSE: The purpose of this project is to help community entities, patients and caregivers, and providers within this community become more familiar with early diagnosis and treatment of dementias/cognitive concerns to improve quality of life for patients and caregivers.

METHODS: The Chronic Care Model was used to guide this quality improvement project which implemented an abbreviated locally tailored KAER Model Toolkit. The Toolkit was designed to aid in the early diagnosis and management of cognitive concerns/dementias in a primary care setting. The PDSA cycle was used to guide the development, implementation, and evaluation of the project.

INTERVENTIONS: After feedback from local entities, a locally-tailored toolkit included the locally tailored KAER Model as well as resources within the KAER Model, which was discussed with local healthcare entities, patients and caregivers to assess for cultural appropriateness and feasibility in a rural island community setting.

EVALUATION: Local healthcare entities, patients, caregivers, and providers will engage in collegial discussion group to form a coalition of key stakeholders within the community. The coalition of stakeholders will assess the KAER Toolkit and a pre-pilot survey will measure stakeholders opinions of the toolkit resources for feasibility of use. A locally tailored version of the KAER Toolkit will then be administered to each group of stakeholders for use. After six months of use in the local community setting, the locally tailored KAER Toolkit was reassessed through a post-pilot survey by the coalition of stakeholders for confidence, helpfulness, resources, feasibility, and necessity of the Toolkit.

RESULTS: The overarching aim of the proposed project, to implement a locally tailored and culturally appropriate Toolkit, to primary care providers to improve accuracy and earlier diagnosis and treatment of patients with cognitive concerns/dementias at a rural Alaska primary care practice over six months was not met. However, the project was successful in convening stakeholders, adapting the KAER Model Toolkit for the local community and evaluating the revised Toolkit. Though there was a percent change evident, there was a minimal difference between the pre and post survey results, which demonstrated that opinions of the stakeholders were not dramatically affected by the implementation phase of this project. Qualitative discussion groups were analyzed and separated by themes that supported the objectives of the project.

DISCUSSION: The stakeholders found the information within the abbreviated, locally tailored Toolkit to be useful and informative. The use of the abbreviated Toolkit improved health literacy through increasing knowledge of community resources for stakeholders. Challenges associated with this project were realized during the implementation period due to the COVID-19 pandemic. The project demonstrates that there is a need for increased health literacy in rural health communities and any quality improvement projects that educates caregivers and family members on a community level can be beneficial to breaking down barriers to improvements in quality care for healthcare entities and healthcare providers. Though this project did not completely meet the aims that were desired, the project can be seen as useful for developing health literacy in rural and remote community settings among stakeholders.