Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—Study protocol

Abstract

Introduction Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs. This report provides an overview of the Health Care Innovation Award aims, study design, and methodology. Methods This is a prospective, quasi-experimental intervention study of 342 community-living Medicare–Medicaid dual eligibles and Medicare-only beneficiaries with dementia in Maryland. Primary analyses will assess the impact of Maximizing Independence at Home-Plus on risk of nursing home long-term care placement, hospitalization, and health care expenditures (Medicare, Medicaid) at 12, 18 (primary end point), and 24 months, compared to a propensity-matched comparison group. Discussion The goals of the Maximizing Independence at Home-Plus model are to improve care coordination, ability to remain at home, and life quality for participants and caregivers, while reducing total costs of care for this vulnerable population. This Health Care Innovation Award project will provide timely information on the impact of Maximizing Independence at Home-Plus care coordination model on a variety of outcomes including effects on Medicaid and Medicare expenditures and service utilization. Participant characteristic data, cost savings, and program delivery costs will be analyzed to develop a risk-adjusted payment model to encourage sustainability and facilitate spread.

Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics

“…See Table S1, published as supplementary material online attached to the electronic version of this paper, for a comparison of MIND-HCIA and MIND-RCT study designs and methods. Further protocol details are described elsewhere (Samus et al, 2017;Samus et al, 2018). Both studies were approved by the Johns Hopkins Medicine Institutional Review Board (IRB).…”

Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study

“…Older adults with ADRD tend to be clinically complex; roughly half have three or more chronic conditions ( Lin et al, 2013 ). They are at elevated risk for avoidable hospitalizations for chronic conditions, hospital readmission, urinary tract infection, sepsis, and other adverse outcomes ( Daiello et al, 2014 ; Lin et al, 2013 ; LinNeumann, 2017; Shen et al, 2012 ), which may be preventable with timely care and effective care ( Amjad et al, 2018 ; Bellantonio et al, 2008 ; Naylor et al, 2014 ; Samus et al, 2014 , 2015 , 2017 , 2018 ).…”

LIVE@Home.Path—innovating the clinical pathway for home-dwelling people with dementia and their caregivers: study protocol for a mixed-method, stepped-wedge, randomized controlled trial

“…This study showed that 18 months of care coordination through individualized care planning, implementation of a care plan, monitoring and reassessment had beneficial effects on the time to transition from home, number of dementiarelated unmet needs, quality of life (QoL) and, importantly, a potentially clinically relevant reduction in selfreported number of hours spent on caregiving tasks, as a measure of caregiver burden [14,15]. Developing this model further, the MIND at Home-Plus study included an additional 340 persons to evaluate the effect on longterm care placement, hospitalization and health-care expenditures of a 24-month homecare coordination program for PWD [16]. The MIND at Home-Streamlined trial is now refining the intervention to investigate its impact on time to long-term care placement, needs, burdens and QoL in PWDs and their caregivers, as well as cost utilization [17].…”