Variations in Costs of a Collaborative Care Model for Dementia

Rosa, Talita D’Aguiar; Possin, Katherine L.; Bernstein, Alissa; Merrilees, Jennifer; Dulaney, Sarah; Matuoka, Jéssica Yumi; Lee, Kirby P.; Chiong, Winston; Bonasera, Stephen J.; Harrison, Krista L.; Kahn, James G.

doi:10.1111/jgs.16076

Cited by 20 publications

(34 citation statements)

References 18 publications

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“…However, there is evidence that the costs of programs for people with dementia can reduce overtime from the start-up phase to the continuing phase of the program (likely due to economies of scale and increased efficiency once the program is up and running). For example, the costs of care-coordination programs in people with dementia decreased from between $501–$581 during the start-up phase for the program, to $142–$241 per participant per month once the programs were up and running in a stable phase (all in US dollars) ( 32 ). Therefore, similar economies of scale and increased efficiency may occur if the dementia-education program were run again in multiple regions.…”

Section: Discussionmentioning

confidence: 99%

A RE-AIM Analysis of an Intergenerational Dementia Education Program

Smith

Kamm

Lai

et al. 2020

Front. Public Health

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Objectives: Children often have a lack of dementia understanding and poor attitudes toward people with dementia. Intergenerational programs are increasingly common, but the effects on knowledge and attitudes related to dementia are mixed, especially in the long-term (6 months). Using a RE-AIM framework, we quantitatively evaluated the effects of an educational dementia program (with and without an intergenerational program) on dementia attitudes in the short and long-term, and qualitatively, which elements of the program facilitated this change. Methods: Eighty-one children (9.63 ± 0.52 years, 35 males) from three classes participated in an 8-week dementia education program and 52 also interacted with older adults through an intergenerational experience. Program reach was measured as the percentage of children who participated in the study. The Kids Insight into Dementia Survey (KIDS) was implemented to measure dementia knowledge and attitudes: efficacy and maintenance. Qualitative interviews with all participant groups informed both adoption and implementation. Cost-benefit analysis was used as a secondary outcome measure for efficacy. Results: The program demonstrated strong levels of impact reaching 93% of school children across the three included classes. Efficacy was demonstrated by a positive change in children's dementia knowledge and attitudes immediately post program, which remained increased (as compared to baseline) 6- months post intervention; there were no differences between groups (those who interacted with older adults and those who did not). Interviews identified positive changes in children's empathy and improved community awareness. Barriers to adoption included the project scope, time constraints incurred by school terms and the management of children-to-adult ratios. Conclusions: These findings provide the first evidence that school-based dementia education improves knowledge of and attitudes toward people with dementia long-term. We demonstrated programs such as this can be successful in both primary school and wider community settings, with support from school and community partners key to the success.

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Section: Discussionmentioning

confidence: 99%

A RE-AIM Analysis of an Intergenerational Dementia Education Program

Smith

Kamm

Lai

et al. 2020

Front. Public Health

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“…Longer continuity of the CTN-dyad relationships at UNMC allowed for higher efficiency. 21 At each hub, a full-time advanced-practice nurse and social worker were co-located with the CTNs, and a pharmacist was available part-time. 21 These expert health care profes-sionals were available for situations beyond the CTN's scope, such as medical needs, problematic behavioral symptoms, complex legal or financial circumstances, and safety concerns.…”

Section: Key Pointsmentioning

confidence: 99%

“…21 At each hub, a full-time advanced-practice nurse and social worker were co-located with the CTNs, and a pharmacist was available part-time. 21 These expert health care profes-sionals were available for situations beyond the CTN's scope, such as medical needs, problematic behavioral symptoms, complex legal or financial circumstances, and safety concerns. The specialists addressed these situations through consultation with the CTN, direct consultation with the dyad, or care coordination with outside health care and service professionals.…”

Section: Key Pointsmentioning

confidence: 99%

Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use

et al. 2019

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IMPORTANCE Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. OBJECTIVE To determine whether the Care Ecosystem is effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care. DESIGN, SETTING, AND PARTICIPANTS A single-blind, randomized clinical trial with a pragmatic design was conducted among PWDs and their caregivers. Each PWD-caregiver dyad was enrolled for 12 months between March 20, 2015, and February 28, 2017. Data were collected until March 5, 2018. Study interventions and assessments were administered over the telephone and internet by clinical and research teams in San Francisco, California, and Omaha, Nebraska. Of 2585 referred or volunteer PWD-caregiver dyads in California, Iowa, or Nebraska, 780 met eligibility criteria and were enrolled. A total of 512 PWD-caregiver dyads were randomized to receive care through the Care Ecosystem and 268 dyads to receive usual care. All eligible PWDs had a dementia diagnosis; were enrolled or eligible for enrollment in Medicare or Medicaid; and spoke English, Spanish, or Cantonese. Analyses were intention-to-treat. INTERVENTION Telephone-based collaborative dementia care was delivered by a trained care team navigator, who provided education, support and care coordination with a team of dementia specialists (advanced practice nurse, social worker, and pharmacist). MAIN OUTCOMES AND MEASURES Primary outcome measure: Quality of Life in Alzheimer's Disease based on caregiver's rating of 13 aspects of PWD's well-being (including physical health, energy level, mood, living situation, memory, relationships, and finances) on a 4-point scale (poor to excellent). Secondary outcomes: frequencies of PWDs' use of emergency department, hospitalization, and ambulance services; caregiver depression (score on 9-Item Patient Health Questionnaire; higher scores indicate more severe depression); and caregiver burden (score on 12-Item Zarit Burden Interview; higher scores indicate more severe caregiver burden). RESULTS The 780 PWDs (56.3% female; mean [SD] age, 78.1 [9.9] years) and 780 caregivers (70.9% female; mean [SD] age, 64.7 [12.0] years) lived in California (n = 452), Nebraska (n = 284), or Iowa (n = 44). Of 780 dyads, 655 were still active at 12 months, and 571 completed the 12-month survey. Compared with usual care, the Care Ecosystem improved PWD quality of life (B, 0.53; 95% CI, 0.25-1.30; P = .04), reduced emergency department visits (B, −0.14; 95% CI, −0.29 to −0.01; P = .04), and decreased caregiver depression (B, −1.14; 95% CI, −2.15 to −0.13; P = .03) and caregiver burden (B, −1.90; 95% CI, −3.89 to −0.08; P = .046). CONCLUSIONS AND RELEVANCE Effective care management for dementia can be delivered from centralized hubs to supplement usual care and mitigate the growing societal and economic b...

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“…Dementia affects more than half of all residents who reside in assisted living facilities [ 1 – 3 ]. Older adults who live with dementia are more likely to experience injuries requiring acute care, be diagnosed with pneumonia, and encounter difficulties with eating [ 4 , 5 ]. Care for dementia is expensive and a widely cited reason for older adults requiring placement in a nursing home [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

et al. 2021

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Background Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. Methods We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. Conclusions A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities.

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Variations in Costs of a Collaborative Care Model for Dementia

Cited by 20 publications

References 18 publications

A RE-AIM Analysis of an Intergenerational Dementia Education Program

A RE-AIM Analysis of an Intergenerational Dementia Education Program

Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use

Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

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