Diagnostic and Therapeutic Protocol (DTP) for Dementia Patients
ASL Milan – Scientific Coordination: Carlo Besta Neurological Institute. Chirchiglia S. – Filippini G. – Morbin M. – Caccioppoli R. – Moser P. – Tramacere I.
Dementia Epidemiology and Clinical Context
According to the National Center for Epidemiology, between 1% and 5% of the population over 65 and up to 30% of those over 80 are affected by dementia. These figures translate into more than 20,000 cases in the city of Milan alone.
Alzheimer’s disease is the most common diagnosis, accounting for over 50% of detected cases. Across Europe, the number of Alzheimer’s patients is expected to exceed 65 million by 2030.
The Carlo Besta Neurological Institute, in collaboration with the Italian Ministry of Health, developed and validated a protocol for the early diagnosis of Alzheimer’s disease. This protocol includes:
- Research on biological and genetic markers
- Diagnostic pathways
- Cognitive and behavioral testing
- Guidelines to improve coordination between hospitals and primary care services focused on dementia
The PDTAR Project: Integrated Dementia Care Pathway
To support this initiative, a dedicated task force was established under the project name:
PDTAR (Preventive – Diagnostic – Therapeutic – Rehabilitation Care Pathways) for Dementia Patients
The task force is led by ASL Milan, with scientific coordination by Dr. Graziella Filippini, Head of the Neuroepidemiology Department at the Besta Institute.
The PDTAR guidelines were developed by Dr. Saverio Chirchiglia, Director of Complex Unit District 4 at ASL Milan, and are based on three key principles:
1. Diagnostic Appropriateness
Accurate diagnosis is essential. Diagnostic or therapeutic errors may:
- Harm patients and their families
- Lead to inappropriate drug use
- Increase hospitalizations
- Generate repeated medical consultations
- Increase emergency department visits
2. Integrated Healthcare Network
The project promotes a multi-stakeholder support network involving:
- General Practitioners (GPs)
- Neurologists and Geriatric specialists
- Fragility Care Centers
- Social services
This integrated approach ensures effective diagnosis, prevention, and treatment of dementia.
3. Central Role of General Practitioners
General Practitioners play a key role by:
- Supporting and informing families
- Identifying at-risk patients
- Assessing and referring patients
- Ensuring continuous follow-up
ACTide’s Role in the Project
ACTide played a central operational role by enabling:
- A shared electronic patient record
- A coordinated workflow between GPs, hospital neurologists, fragility centers, care operators, and the central coordination unit
This resulted in full alignment and collaboration among all stakeholders.
- Integration with the Agor@sl portal (ASL Milan information system)
- Database setup and data retrieval/export tools
- Secure and validated cloud-based hosting
- Training sessions for General Practitioners
Critical Success Factors
- Rapid delivery timelines
- High interoperability requirements
March 31, 2013
Completion of clinical specialist recruitment. Once the required number of participants was reached, the project was confirmed and IT infrastructure implementation began.
May 15, 2013
- Launch of the Dementia application
- First training session for General Practitioners
Interoperability with Agor@sl
One of the key project requirements was enabling General Practitioners to:
- Use a single login
- Create patient records
- Automatically import existing patient data from the ASL system
This was essential to ensure active participation and a consistent flow of case reporting aligned with epidemiological expectations (estimated 22–27 cases per GP).
Within days of project assignment, Nubilaria developed a strategy to ensure full interoperability via secure web services, in collaboration with Dr. Stefano Beligni (ASL Milan IT Services).
Project Outcomes
The implementation of PDTAR delivered significant improvements:
- Increased appropriateness of specialist referrals
- Greater awareness of dementia among General Practitioners
- Improved ability to independently assess patients using tools such as the Mini-Mental State Examination (MMSE)
- Immediate adoption of the shared electronic health record
- Enhanced communication between GPs and specialists
Operational Impact
- GP compliance exceeded expectations in terms of reported and managed cases
- The coordination center provided organizational support to patients, families, and healthcare professionals
- A fast-track pathway for suspected cognitive decline reduced waiting times for specialist visits
Project Scale and Numbers
- 2,800 patients with early cognitive impairment or dementia
- 500 General Practitioners
- 18 local outpatient clinics (Neurology and Geriatrics) within ICP hospitals
- 13 Alzheimer Evaluation Units (UVA)
- 19 district Fragility Centers
- 19 territorial Fragility Points