The Effects of Dementia Care Co-Management on Acute Care, Hospice, and Long-Term Care Utilization
- PMID: 32573765
- DOI: 10.1111/jgs.16667
The Effects of Dementia Care Co-Management on Acute Care, Hospice, and Long-Term Care Utilization
Abstract
Background/objectives: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data.
Design: Quasi-experimental controlled before-and-after comparison.
Setting: Urban academic medical center.
Participants: A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients.
Intervention: Dementia co-management model using nurse practitioners partnered with primary care providers and community organizations.
Measurements: Average difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life.
Results: Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37).
Conclusion: Comprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.
Keywords: care management; dementia; healthcare utilization.
© 2020 The American Geriatrics Society.
Comment in
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How Do We Make Comprehensive Dementia Care a Benefit?J Am Geriatr Soc. 2020 Nov;68(11):2486-2488. doi: 10.1111/jgs.16805. Epub 2020 Sep 25. J Am Geriatr Soc. 2020. PMID: 32975816 Free PMC article. No abstract available.
References
REFERENCES
-
- Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2006;295(18):2148-2157.
-
- Callahan CM, Boustani MA, Weiner M, et al. Implementing dementia care models in primary care settings: the Aging Brain Care Medical Home. Aging Ment Health. 2011;15(1):5-12.
-
- Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145(10):713-726.
-
- Jennings LA, Tan Z, Wenger NS, et al. Quality of care provided by a comprehensive dementia care comanagement program. J Am Geriatr Soc. 2016;64(8):1724-1730.
-
- Possin KL, Merrilees JJ, Dulaney S, et al. Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the care ecosystem randomized clinical trial. JAMA Intern Med. 2019;179:1658-1667.
