The potential of case management for people with dementia: a commentary

Koch, Tamar; Iliffe, Steve; Manthorpe, Jill; Stephens, Barbara; Fox, Chris; Robinson, Louise; Livingston, Gill; Coulton, Simon; Knapp, Martín; Chew‐Graham, Carolyn

doi:10.1002/gps.3783

Cited by 40 publications

(50 citation statements)

References 30 publications

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“…11,23 This study examined the impact of the PDC intervention on VHA health care costs. 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.…”

Section: Discussionmentioning

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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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: 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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“…A number of systematic reviews have been reported of studies assessing the impact of case management on older people with dementia. [183][184][185][186][187][188][189] In general, studies have provided conflicting information about the potential benefits and duration of effect of case management for people with dementia. A recent Cochrane review of case management for PLWD found that the case management group was significantly less likely to be institutionalised at 6 and 12 months than those not receiving case management, although the longer-term effects were uncertain.…”

Section: Co-ordination and Navigationmentioning

confidence: 99%

“…191 Furthermore, it is not clear which population of people with dementia is most likely to benefit from case management and at what stage of the dementia trajectory. 185 Studies have, however, identified a number of characteristics that appear to be important for the success of case management and care co-ordination. These include strong provider and care networks, good personal connections with other HCPs, expert knowledge, embedding in the multidisciplinary team, the involvement of GPs, intensive and proactive approaches and clearly defined skills and responsibilities.…”

Section: Co-ordination and Navigationmentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…A systematic review of models of care for depression suggested that components that were found to significantly predict improvement were (1) the revision of professional roles; (2) the provision of a case manager who provided direct feedback and delivered a psychological therapy; and (3) an intervention that incorporated patient preferences into care. 23 The evidence base A literature review 24 published as part of the preliminary work for this study provided a commentary on case management interventions for people with dementia and a summary of its findings are provided here. The review set out to address (1) what are case managers and how do they relate to dementia care; (2) whether or not dementia care can be improved by case management; (3) what people with dementia and their carers want from a case manager and whether or not this can be provided; (4) whether or not we can measure the cost-effectiveness of case management; and (5) what direction research into case management needs to take.…”

Section: Care Co-ordinationmentioning

confidence: 99%

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study

Iliffe

Waugh

Poole

et al. 2014

Health Technology Assessment

227

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BackgroundPeople with dementia and their families need support in different forms, but currently services are often fragmented with variable quality of care. Case management offers a way of co-ordinating services along the care pathway and therefore could provide individualised support; however, evidence of the effectiveness of case management for dementia is inconclusive.ObjectiveTo adapt the intervention used in a promising case management project in the USA and test its feasibility and acceptability in English general practice.DesignIn work package 1, a design group of varied professionals, with a carer and staff from the voluntary sector, met six times over a year to identify the skills and personal characteristics required for case management; protocols from the US study were adapted for use in the UK. The feasibility of recruiting general practices and patient–carer dyads and of delivering case management were tested in a pilot study (work package 2). An embedded qualitative study explored stakeholder views on study procedures and case management.SettingFour general practices, two in the north-east of England (Newcastle) one in London and one in Norfolk, took part in a feasibility pilot study of case management.ParticipantsCommunity-dwelling people with dementia and their carers who were not already being case managed by other services.InterventionA social worker shared by the two practices in the north-east and practice nurses in the other two practices were trained to deliver case management. We aimed to recruit 11 people with dementia from each practice who were not already being case managed.Main outcome measuresNumbers of people with dementia and their carers recruited, numbers and content of contacts, needs identified and perceptions of case management among stakeholders.ResultsRecruitment of practices and patients was slow and none of the practices achieved its recruitment target. It took more than 6 months to recruit a total of 28 people with dementia. Practice Quality and Outcome Framework registers for dementia contained only 60% of the expected number of people, most living in care homes. All stakeholders were positive about the potential of case management; however, only one of the four practices achieved a level of case management activity that might have influenced patient and carer outcomes. Case managers’ activity levels were not related solely to time available for case management. Delivery of case management was hindered by limited clarity about the role, poor integration with existing services and a lack of embeddedness within primary care. There were discrepancies between case manager and researcher judgements about need, and evidence of a high threshold for acting on unmet need. The practice nurses experienced difficulties in ring-fencing case management time.ConclusionsThe model of case management developed and evaluated in this feasibility study is unlikely to be sustainable in general practice under current conditions and in our view it would not be appropriate to attempt a definitive trial of this model. This study could inform the development of a case management role with a greater likelihood of impact. Different approaches to recruiting and training case managers, and identifying people with dementia who might benefit from case management, are needed, as is exploration of the scale of need for this type of working.Trial registrationCurrent Controlled Trials ISRCTN74015152.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 18, No. 52. See the NIHR Journals Library website for further project information.

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The potential of case management for people with dementia: a commentary

Abstract: Aim: To propose a research agenda on case management for people with dementia.Background: A recent review of studies of case management in dementia argues that

Cited by 40 publications

References 30 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

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

The effectiveness of collaborative care for people with memory problems in primary care: results of the CAREDEM case management modelling and feasibility study

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