Caring for Patients with Dementia: How Good Is the Quality of Care? Results from Three Health Systems

Department of Family and Preventive Medicine, University of California, San Diego, San Diego, California, United States
Journal of the American Geriatrics Society (Impact Factor: 4.57). 09/2007; 55(8):1260-8. DOI: 10.1111/j.1532-5415.2007.01249.x
Source: PubMed


To describe the quality of dementia care within one U.S. metropolitan area and to investigate associations between variations in quality and patient, caregiver, and health system characteristics.
Observational, cross-sectional.
Three hundred eighty-seven patient-caregiver pairs from three healthcare organizations
Using caregiver surveys and medical record abstraction to assess 18 dementia care processes drawn from existing guidelines, the proportion adherent to each care process was calculated, as well as mean percentages of adherence aggregated within four care dimensions: assessment (6 processes), treatment (6 processes), education and support (3 processes), and safety (3 processes). For each dimension, associations between adherence and patient, caregiver, and health system characteristics were investigated using multivariable models.
Adherence ranged from 9% to 79% for the 18 individual care processes; 11 processes had less than 40% adherence. Mean percentage adherence across the four care dimensions was 37% for assessment, 33% for treatment, 52% for education and support, and 21% for safety. Higher comorbidity was associated with greater adherence across all four dimensions, whereas greater caregiver knowledge (in particular, one item) was associated with higher care quality in three of four care dimensions. For selected dimensions, greater adherence was also associated with greater dementia severity and with more geriatrics or neurologist visits.
In general, dementia care quality has considerable room for improvement. Although greater comorbidity and dementia severity were associated with better quality, caregiver knowledge was the most consistent caregiver characteristic associated with better adherence. These findings offer opportunities for targeting low quality and suggest potential focused interventions.

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    • "For example, a study of dementia care in the US found that concordance with a number of dementia care process measures (drawn from guideline recommendations) ranged from 9% to 79%, with concordance for 11 of these processes being less than 40% [15]. Formal cognitive assessment may not be conducted in as many as 30% to 50% of cases [15,18]. Similar findings have been reported in relation to assessment for co-morbid depression in patients being evaluated for dementia [15,16,18]. "
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    • "Seven RCT studies were excluded as they did not assess organizational outcomes (Wells et al., 2000; Burgio et al., 2001; 2002; Teri et al., 2005a; Chodosh et al., 2007; Davison et al., 2007; Visser et al., 2008). Chodosh et al. (2007) did assess quality of care delivered; however, this was measured from the primary care physician's perspective and therefore was not a true organizational outcome. One intervention tested by Smyer et al. (1992) was not focused on dementia, but instead on general training in nursing home care, and was therefore excluded despite assessing changes in job roles. "
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