The Effect of Telephone Support Groups on Costs of Care for Veterans With Dementia

Wray, Laura O.; Shulan, Mollie; Toseland, Ronald W.; Freeman, Kurt; Vásquez, Bob Edward; Gao, Jian

doi:10.1093/geront/gnq040

Cited by 50 publications

(83 citation statements)

References 25 publications

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“…Our study was powered to detect small to moderate differences in change in cost, on the order of those observed by Wray et al 25 Further work with substantially larger samples could help to determine whether the small cost differences we observed exist.…”

Section: Discussionmentioning

confidence: 89%

“…We incorporated an indicator of veteran priority levels to help control for the impact of service priority on change in VHA cost. Wray et al 25 concluded that Medicare use in their study by veterans with dementia was minimal compared to VHA use among the same group of veterans. However, without measures of non-VHA health care use, we cannot determine whether PDC affected VHA care and non-VHA care access differentially.…”

Section: Discussionmentioning

confidence: 99%

“…[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. However, the total cost decrease variable was not maintained over the subsequent 6 months, possibly because the TEP was not continued beyond the completion of the 10-week program.…”

Section: Discussionmentioning

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: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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“…Within the VISN 2 population, the veterans whose caregivers participated in the telephone support and education program have been shown to have significantly decreased healthcare costs compared with veterans receiving usual care. 32 It may be challenging to implement similar programs outside the VA system where EMR technology is more limited, if available, and may not contain all the patient information available within the VA system. Conversely, Medicare now requires annual assessment for cognitive impairment, 42 and community practices that accept Medicare patients will soon need to develop strategies to attend to this issue.…”

Section: Discussionmentioning

confidence: 99%

A Program to Improve Detection of Undiagnosed Dementia in Primary Care and Its Association with Healthcare Utilization

Wray

Wade

Beehler

et al. 2014

The American Journal of Geriatric Psychiatry

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“…Examples include psychiatry 133 (including depression [134][135][136] and dementia 137 ), dermatology, [138][139][140][141][142][143][144] sleep apnea, 145 The following analysis is based on 14 cost studies ( Table 4) dealing with one or more of the target chronic diseases in this article and is organized on the basis of the particular cost method used in the study.…”

Section: Cost Studiesmentioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

294

210

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The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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The Effect of Telephone Support Groups on Costs of Care for Veterans With Dementia

Abstract: The TEP caregiver intervention resulted in short-term cost savings for veteran care recipients. Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes.

Cited by 50 publications

References 25 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

A Program to Improve Detection of Undiagnosed Dementia in Primary Care and Its Association with Healthcare Utilization

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

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