دورية أكاديمية
Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial.
| العنوان: | Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial. |
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| المؤلفون: | Guterman EL; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco.; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco., Kiekhofer RE; Department of Neurology, University of California, San Francisco., Wood AJ; Department of Neurology, University of California, San Francisco., Allen IE; Department of Epidemiology & Biostatistics, University of California, San Francisco., Kahn JG; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco., Dulaney S; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco., Merrilees JJ; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco., Lee K; Department of Clinical Pharmacy, University of California, San Francisco., Chiong W; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco., Bonasera SJ; Department of Medicine, Division of Geriatrics and Palliative Care, UMass Chan Medical School-Baystate, Springfield, Massachusetts., Braley TL; Department of Geriatrics, Gerontology and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha., Hunt LJ; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.; Department of Physiological Nursing, University of California, San Francisco.; The Global Brain Health Institute, University of California, San Francisco., Harrison KL; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco., Miller BL; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco.; The Global Brain Health Institute, University of California, San Francisco., Possin KL; Department of Neurology, University of California, San Francisco.; Weill Institute for Neurosciences, University of California, San Francisco.; The Global Brain Health Institute, University of California, San Francisco. |
| المصدر: | JAMA internal medicine [JAMA Intern Med] 2023 Nov 01; Vol. 183 (11), pp. 1222-1228. |
| نوع المنشور: | Randomized Controlled Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S. |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589534 Publication Model: Print Cited Medium: Internet ISSN: 2168-6114 (Electronic) Linking ISSN: 21686106 NLM ISO Abbreviation: JAMA Intern Med Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Medicare* , Dementia*/therapy, Humans ; Aged ; Female ; United States ; Ecosystem ; Single-Blind Method ; Health Care Costs |
| مستخلص: | Importance: Collaborative dementia care programs are effective in addressing the needs of patients with dementia and their caregivers. However, attempts to consider effects on health care spending have been limited, leaving a critical gap in the conversation around value-based dementia care. Objective: To determine the effect of participation in collaborative dementia care on total Medicare reimbursement costs compared with usual care. Design, Setting, and Participants: This was a prespecified secondary analysis of the Care Ecosystem trial, a 12-month, single-blind, parallel-group randomized clinical trial conducted from March 2015 to March 2018 at 2 academic medical centers in California and Nebraska. Participants were patients with dementia who were living in the community, aged 45 years or older, and had a primary caregiver and Medicare fee-for-service coverage for the duration of the trial. Intervention: Telehealth dementia care program that entailed assignment to an unlicensed dementia care guide who provided caregiver support, standardized education, and connection to licensed dementia care specialists. Main Outcomes and Measures: Primary outcome was the sum of all Medicare claim payments during study enrollment, excluding Part D (drugs). Results: Of the 780 patients in the Care Ecosystem trial, 460 (59.0%) were eligible for and included in this analysis. Patients had a median (IQR) age of 78 (72-84) years, and 256 (55.7%) identified as female. Participation in collaborative dementia care reduced the total cost of care by $3290 from 1 to 6 months postenrollment (95% CI, -$6149 to -$431; P = .02) and by $3027 from 7 to 12 months postenrollment (95% CI, -$5899 to -$154; P = .04), corresponding overall to a mean monthly cost reduction of $526 across 12 months. An evaluation of baseline predictors of greater cost reduction identified trends for recent emergency department visit (-$5944; 95% CI, -$10 336 to -$1553; interaction P = .07) and caregiver depression (-$6556; 95% CI, -$11 059 to -$2052; interaction P = .05). Conclusions and Relevance: In this secondary analysis of a randomized clinical trial among Medicare beneficiaries with dementia, the Care Ecosystem model was associated with lower total cost of care compared with usual care. Collaborative dementia care programs are a cost-effective, high-value model for dementia care. Trial Registration: ClinicalTrials.gov Identifier: NCT02213458. |
| معلومات مُعتمدة: | K76 AG074924 United States AG NIA NIH HHS; K01 AG059831 United States AG NIA NIH HHS; P30 AG044281 United States AG NIA NIH HHS; L30 AG060590 United States AG NIA NIH HHS; R35 AG072362 United States AG NIA NIH HHS; R01 AG056715 United States AG NIA NIH HHS; R01 AG074710 United States AG NIA NIH HHS |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02213458 |
| تواريخ الأحداث: | Date Created: 20230918 Date Completed: 20231107 Latest Revision: 20240430 |
| رمز التحديث: | 20240430 |
| مُعرف محوري في PubMed: | PMC10507595 |
| DOI: | 10.1001/jamainternmed.2023.4764 |
| PMID: | 37721734 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6114 |
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| DOI: | 10.1001/jamainternmed.2023.4764 |