Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial

Abstract

Objective: To investigate effects of a novel dementia care coordination program on health services utilization.

Data sources/study setting: A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011).

Study design: Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team.

Data collection/extraction methods: Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months.

Principal findings: From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005).

Conclusions: While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use.

Keywords: Dementia; care coordination.

Figure 1

(a–c) Home‐ and Community‐Based Services (HCBS) Use in Intervention and Augmented Usual Care Groups over Time, Adjusted for Living with a Caregiver, Total Medications, and Psychogeriatric Dependency Rating Scale‐Physical Score Notes. (a) Categories of HCBS health use include Care Management, Visiting Nurse Services, Physical Therapy, Speech/Occupational Therapy, Transportation to Health Services, Adaptive/Assistive Supplies. The rate of increase in mean categories of HCBS health used from baseline to 18 months was similar between groups (p = .383). (b) Categories of HCBS social service use include Social Day Care, Congregate Meals, Companion Services, and Patient Support Groups. The change in mean categories of social services used was similar between groups from baseline to 9 months (p = .139), but the increase in the intervention group was significantly higher from baseline to 18 months. (p = .026). (c) Categories of HCBS support service use include In‐Home Respite Care, Home Delivered Meals, Homemaker/Housekeeping, Live‐in Paid Caregiver, and Client Education Training Services. The change in mean categories of support services used was similar between groups from baseline to 9 months (p = .561), but the increase in the intervention group was significantly higher from baseline to 18 months (p = .008).