Caregiver Outcomes of Partners in Dementia Care: Effect of a Care Coordination Program for Veterans with Dementia and Their Family Members and Friends

Abstract

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care-coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer's Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e-mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer's Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more-limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer's Disease and a proposed amendment to the Older Americans Act.

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.…”

“…Finally, while the PDC study overall has documented improvements in clinical outcomes for veterans' caregivers, 7 we did not assess health care use by caregivers. Consequently, it is not clear whether PDC affected caregivers' health care use, or, if so, in which direction.…”

“…[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.…”

An evidence-based technological caregiver skill building intervention for dementia family caregivers: pilot study

“…In the fourth, and present phase of caregiver intervention research (2006 to present) there has been greater focus on the full continuum of dementia (i.e., early phase to end-of-life) [21], as well as greater use of innovative technology [25], multidisciplinary teams, collaborative primary care management models [21,[26][27], and dyadic focused interventions [28]. Nonetheless, continuing challenges with ADRD family caregiver interventions need to be addressed, such as translating these interventions and adapting them for integration into a care delivery setting and testing them on a larger scale [21].…”