Joshua Chodosh1,2,3, Benjamin Colaiaco4, Karen I. Connor1,2, Dennis Cope1,5, Hangsheng Liu3,6, David A. Ganz1,2,3, Mark Richman1,5, Debra Cherry7,8,9, Joseph Moshe Blank1,5, Raquel del Pilar Carbone10, Sheldon M. Wolf1,5, Barbara G. Vickrey1,2,3
11University of California, Los Angeles, USA
22Veteran Affairs Greater Los Angeles Healthcare System, CA, USA
33RAND Corporation, Santa Monica, CA, USA
4RAND Corporation, Santa Monica, CA, USA
54Olive View-UCLA Medical Center, Los Angeles, USA
6RAND Corporation, Boston, MA, USA
77University of Southern California, Los Angeles, USA
8Alzheimer’s Association, Los Angeles, CA, USA
9University of Southern California, Los Angeles, USA
10Veteran Affairs Greater Los Angeles Healthcare System, CA, USA
Tóm tắt
Objectives: To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia. Methods: We randomized 151 patient–caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient–caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up. Results: Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver. Discussion: Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected.
