A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

Abstract

Introduction“Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia.Methods and FindingsFive matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate.ResultsOf 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided.ConclusionsPartnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia.Trial RegistryNCT00291161

A Break-Even Analysis for Dementia Care Collaboration: Partners in Dementia Care

“…In our study, the model-adjusted costs for veterans receiving the PDC intervention were not significantly higher than those for the veterans in the control arm, while, as we have documented elsewhere, veterans and their caregivers receiving PDC showed improvements in care outcomes. [7][8][9] Similar to the results in our study, those reported by Duru et al, 24 who examined the implementation of a social workeroriented intervention focused on problem and action plan prioritization, identified improvements in care quality but no differences in health care costs. Wray et al 25 noted an average decrease in total costs of $2,768/patient over 6 months, with a statistically significant reduction in costs for veterans in their intervention group (Telehealth Education Program [TEP]) over the intervention period and immediately following the intervention.…”

“…27 Their findings are heartening in light of the similarity to what we have seen with PDC; however, they suggest that it may be important to track costs over longer periods than those used in our study. Long and colleagues 28 projected that the (2)(3)(4)(5)(6) 0.34*** 0.10 Priority group (7,8) Ref . savings from a successful dementia caregiver intervention could be substantial over the long term (15-year period), but that it might take several years to begin accruing.…”

“…VHA health service cost data were obtained from the national data extract files of the VHA's Decision Support Dementia, unspecified, with/without behavioral disturbance 294. 8 Other persistent mental disorders due to conditions classified elsewhere 331.0…”

“…[4][5][6] PDC has been shown to lessen dementia-related needs and improve psychosocial outcomes for patients and caregivers. [4][5][6][7][8][9] Notwithstanding the demonstrated effectiveness of PDC in reducing distress for both veterans with dementia and their caregivers, providers such as the VHA cannot make policy decisions on the basis of effectiveness alone. The literature on cost savings of non-pharmacologic therapies, including those focusing on organization of care, is relatively small and inconclusive.…”

Caregiver burden assessed in dementia care networks in Germany: findings from the DemNet-D study baseline

“…Although some implications can be drawn from integrated care studies, evidencebased research specifically on DCNs and their potential for improving the support of PwDs and their caregivers is still rare. To date, few DCN studies have been published, including studies of DCNs in Germany , Canada (Lemieux-Charles et al, 2005), and the USA (Bass et al, 2014;Kally, Cherry, Howland, & Villarruel, 2014). This gap in DCN research was addressed in the 'multi-centered, interdisciplinary evaluation study of DCNs in Germany (DemNet-D),' funded by the Federal Ministry of Health (BMG) of Germany.…”