Partners in Dementia Care: A Care Coordination Intervention for Individuals With Dementia and Their Family Caregivers

Judge, Katherine S.; Bass, David M.; Snow, A. Lynn; Wilson, Nancy; Morgan, Robert O.; Looman, Wendy J.; McCarthy, Catherine; Kunik, Mark E.

doi:10.1093/geront/gnq097

Cited by 80 publications

(161 citation statements)

References 18 publications

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“…Although PDC targeted recruitment of veteran-caregiver dyads, veterans with dementia could enroll without a caregiver. 13 A total of 1,726 veterans were referred to the project and mailed IRBapproved study information and consent forms. Signed consent forms were received for 508 veterans and 486 caregivers.…”

Section: Methodsmentioning

confidence: 99%

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

Morgan¹,

Bass

Judge

et al. 2015

J GEN INTERN MED

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BACKGROUND: Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the BPartners in Dementia Care^(PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. OBJECTIVE: We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. DESIGN: This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. PARTICIPANTS: Study subjects were veterans (N=434) 50 years of age and older with dementia and their caregivers at two intervention (N=269) and three comparison sites (N=165). INTERVENTIONS: PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. MAIN MEASURES: We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. KEY RESULTS: Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre-to post-baseline periods. Pre-baseline log cost (p≤0.001), baseline cognitive impairment (p≤0.05), number of personal care dependencies (p≤0.01), and VA service priority (p≤0.01) all predicted change in log total cost. CONCLUSIONS: These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost, structured, protocol-driven, evidence-based method for effectively delivering care coordination.KEY WORDS: costs and cost analysis; dementia; veterans.

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Section: Methodsmentioning

confidence: 99%

“…In the context of a clinically successful program such as PDC, we posited that findings that were either costneutral or cost-reducing could be interpreted as Bcost successfulf or a health care system such as the VHA. For a complete description of the PDC protocol, see Judge et al 13 …”

Section: Introductionmentioning

confidence: 99%

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

Morgan¹,

Bass

Judge

et al. 2015

J GEN INTERN MED

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“…1, 2 Many family caregivers have multiple, varied, and serious unmet financial, physical, emotional, and social needs. In order to continue providing care, family caregivers need assistance and support so that their physical and mental health needs are met rather than compromised (Judge et al, 2011). A systematic and well-designed assessment can help identify a caregiver's needs and strengths (Feinberg & Hauser, 2012) and, in turn, contribute to a plan of care that ensures the well-being of both care partners (i.e., the caregiver and care recipient).…”

Section: The Importance Of Family Caregiver Assessmentmentioning

confidence: 99%

Family caregivers of individuals with spinal cord injury: exploring the stresses and benefits

et al. 2016

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II About Family Caregiver AllianceFamily Caregiver Alliance (FCA) was founded in 1977 to focus attention on and develop supports for family caregivers of adults with chronic care impairments and in particular, those adults with cognitive impairments such as Alzheimer's disease and related dementias, stroke, Parkinson's disease, and traumatic head injury. FCA's mission is to improve the quality of life for family caregivers through services, education, research and public policy.FCA is recognized as a pioneer for work in developing and delivering high quality caregiver support services and interventions, consumer information, training and capacity building, service and policy research and policy development and advocacy at the state and federal levels. In 2001, FCA established the National Center on Caregiving (NCC). The mission of the NCC is to advance the development of high-quality, costeffective policies and programs for caregivers in every state in the country. It serves as a central resource on caregiving and long-term care issues for policy makers, service providers, media and family caregivers throughout the country. About Benjamin Rose Institute on AgingBenjamin Rose Institute on Aging, established in 1908, is a non-profit organization with the mission to advance the health, independence, and dignity of older adults.The Margaret Blenkner Research Institute (MBRI) of Benjamin Rose is one of the oldest nonacademic research centers in the United States. Founded in 1961, the MBRI is internationally recognized for its applied gerontological research focusing on developing and evaluating evidence-based services and model interventions for older adults and their family members. MBRI staff publish widely and many of these articles and books have helped shape the growing body of knowledge in gerontology.

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“…16,17 The effects on the needs for early diagnosis, financial and legal aspects of the disease, and meaningful activities were not studied. CM was not found to have any effect on patients' daily activities, cognition and depression.A meta-analysis of the effects of CM (Figure 1 and Supplemental Appendix 4, available at http:// 61,62,66,73,74,76,81,85,91,93,95,97 Canada 84 USA [14][15][16] Europe (21 studies) UK 20,52,53,64,69,72,77,78,83,84,99 The Netherlands The effect on depression of caregivers was uncertain (SMD -0.23, 95% CI, -0.46 to 0.01, P = .06), 14,17,18 and there was no effect on caregivers' burden (SMD 0.17, 95% CI, -0.18 to 0.52, P = .34). …”

mentioning

confidence: 99%

“…Education/ counseling [59][60][61][62][63][64][65][66][67][68][72][73][74][75]79,80,82,[85][86][87][88][89][92][93][94][95][96][97] Need for specific information on medical and interpersonal aspects of the disease, meaningful counseling on dealing with behavioral problems, guidelines on dementia before and after diagnosis.…”

mentioning

confidence: 99%

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

Khanassov

Vedel

2016

Ann Fam Med

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PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patientcaregiver dyad and the effects of CM. METHODSWe searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified.RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care.CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patientcaregiver dyad. 2016;14:166-177. doi: 10.1370/afm.1898. Ann Fam Med INTRODUCTIONT he proportion of people with dementia is growing dramatically. According to the US Alzheimer's Association, by 2030, 50% of Americans aged 65 years and older will be diagnosed with dementia. 1 In Canada in 2011, 747,000 Canadians lived with cognitive impairment.2 Today, the combined costs are $33 billion per year, 1 and they are projected to increase to $872 billion by 2038. 3,4 Worldwide, dementia is the main contributor to disability-adjusted life years (11.2%), representing a greater burden than cerebral vascular accident (9.5%), heart disease (5.0%), or cancer (2.4%). 5People with dementia need help with challenging changes in behavior, memory, physical disability, and mood. 6 The main source of help is family caregivers, who often suffer from the burdens of caregiving and from depression and health problems. 7 It has been shown that early intervention makes the greatest difference in management of symptoms. 1 The World Health Organization states that it would be challenging to intervene without effective involvement of primary care. 8 Dementia case management (CM) interventions are becoming a central component of primary health care organizations in North America and Europe. [9][10][11][12] According to the 167Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communi...

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Partners in Dementia Care: A Care Coordination Intervention for Individuals With Dementia and Their Family Caregivers

Cited by 80 publications

References 18 publications

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

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

Family caregivers of individuals with spinal cord injury: exploring the stresses and benefits

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

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