Article

The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care: A Randomized, Controlled Trial

University of California, Riverside, Riverside, California, United States
Annals of internal medicine (Impact Factor: 17.81). 11/2006; 145(10):713-26. DOI: 10.7326/0003-4819-145-10-200611210-00004
Source: PubMed

ABSTRACT

Adherence to dementia guidelines is poor despite evidence that some guideline recommendations can improve symptoms and delay institutionalization of patients.
To test the effectiveness of a dementia guideline-based disease management program on quality of care and outcomes for patients with dementia.
Clinic-level, cluster randomized, controlled trial.
3 health care organizations collaborating with 3 community agencies in southern California.
18 primary care clinics and 408 patients with dementia age 65 years or older paired with 408 informal caregivers.
Disease management program led by care managers and provided to 238 patient-caregiver pairs at 9 intervention clinics for more than 12 months.
Adherence to 23 guideline recommendations (primary outcome) and receipt of community resources and patient and caregiver health and quality-of-care measures (secondary outcomes).
The mean percentage of per-patient guideline recommendations to which care was adherent was significantly higher in the intervention group than in the usual care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI, 25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher care quality on 21 of 23 guidelines (P < or = 0.013 for all), and higher proportions received community agency assistance (P < or = 0.03) than those who received usual care. Patient health-related quality of life, overall quality of patient care, caregiving quality, social support, and level of unmet caregiving assistance needs were better for participants in the intervention group than for those in the usual care group (P < 0.05 for all). Caregiver health-related quality of life did not differ between the 2 groups.
Participants were well-educated, were predominantly white, had a usual source of care, and were not institutionalized. Generalizability to other patients and geographic regions is unknown. Also, costs of a care management program under fee-for-service reimbursement may impede adoption.
A dementia guideline-based disease management program led to substantial improvements in quality of care for patients with dementia. Current Controlled Trials identifier: ISRCTN72577751.

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Available from: Barbara G Vickrey, Dec 01, 2014
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    • "Satisfaction with case management is often high (De Lange & Pot, 2007; Minkman et al., 2009), and some studies have also shown positive effects on clinical outcomes (Callahan et al., 2006; Vickrey et al., 2006). However, studies on the effects or evaluations of case management have produced varying results (e.g. "
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    ABSTRACT: This paper focuses on the evaluation of dementia case management in the Netherlands, as well as factors associated with positive evaluations of informal caregivers. A survey was completed by 554 informal carers. The majority of the informal carers were older (69% was 55+), and female (73%), and often concerned the partner or adult children of the person with dementia. Eighty percent indicated that the contact with the case manager facilitated their role as informal carer, while 95% or more stated that the case manager showed sufficient understanding, allowed enough space to decide together on how to approach problems in the care, took time to listen to their story, gave sufficient attention to and showed interest in their relative, took their schedule into account and/or kept appointments. Contrary to the expectations, multilevel analyses did not show association between informal caregivers' care burden and the evaluation of case management. Neither were the period living with dementia and the number of personal contacts with the case manager associated with the evaluations of informal caregivers. However, being the partner of the patient was significantly related (p < 0.05) to a positive overall evaluation by informal carers. These results suggest that sufficient case management resources should be offered and targeted especially towards partners of people with dementia.
    Full-text · Article · Nov 2015 · Dementia
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    • "Despite a lack of difference between treatment arms, quality of care process indicators had considerably greater adherence across both treatment arms with all quality indicators demonstrating higher adherence at follow-up; 11 out of 19 indicators achieved more than double the proportion of completed indicators at baseline. Moreover, comparisons to quality of care data from the ACCESS study (Vickrey et al., 2006; see Table 6) using the same indicators, demonstrates comparable proportional increases in adherence with higher proportional increases in adherence in 7 of the 12 follow-up indicators. "
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    ABSTRACT: To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected. © The Author(s) 2015.
    Full-text · Article · Feb 2015 · Journal of Aging and Health
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    • "Vickrey et al have suggested that fee-for-service remuneration can limit adoption of CM.10 In contrast, capitation under Medicare-managed care is more likely to favor CM becoming the “usual” practice.10 "
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    ABSTRACT: Background The purpose of this study was to examine factors associated with the implementation of case management (CM) interventions in primary health care (PHC) and to develop strategies to enhance its adoption by PHC practices. Methods This study was designed as a systematic mixed studies review (including quantitative and qualitative studies) with synthesis based on the diffusion of innovation model. A literature search was performed using MEDLINE, PsycInfo, EMBASE, and the Cochrane Database (1995 to August 2012) to identify quantitative (randomized controlled and nonrandomized) and qualitative studies describing the conditions limiting and facilitating successful CM implementation in PHC. The methodological quality of each included study was assessed using the validated Mixed Methods Appraisal Tool. Results Twenty-three studies (eleven quantitative and 12 qualitative) were included. The characteristics of CM that negatively influence implementation are low CM intensity (eg, infrequent follow-up), large caseload (more than 60 patients per full-time case manager), and approach, ie, reactive rather than proactive. Case managers need specific skills to perform their role (eg, good communication skills) and their responsibilities in PHC need to be clearly delineated. Conclusion Our systematic review supports a better understanding of factors that can explain inconsistent evidence with regard to the outcomes of dementia CM in PHC. Lastly, strategies are proposed to enhance implementation of dementia CM in PHC.
    Full-text · Article · Jun 2014 · Clinical Interventions in Aging
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