Coordinated Care Program For Dementia Patients Reduced Need For Nursing Home Placement

MedicalResearch.com Interview with:

Lee A. Jennings, MD, MSHS Assistant Professor of Medicine Director, Oklahoma Healthy Aging Initiative Reynolds Department of Geriatric Medicine University of Oklahoma Health Sciences Center Oklahoma City, OK 73117

Dr. Jennings

Lee A. Jennings, MD, MSHS
Assistant Professor of Medicine
Director, Oklahoma Healthy Aging Initiative
Reynolds Department of Geriatric Medicine
University of Oklahoma Health Sciences Center
Oklahoma City, OK 73117

MedicalResearch.com: What is the background for this study?

Response: The research study focused on a novel model of care for persons living with Alzheimer’s disease and other types of dementia, the UCLA Alzheimer’s and Dementia Care Program. In the program, people with dementia and their caregivers meet with a nurse practitioner specializing in dementia care for a 90-minute in-person assessment and then receive a personalized dementia care plan that addresses the medical, mental health and social needs of both people. The nurse practitioners work collaboratively with the patient’s primary care provider and specialist physicians to implement the care plan, including adjustments as needs change over time.

The research was designed to evaluate the costs of administering the program, as well as the health care services used by program participants, including hospitalizations, emergency room visits, hospital readmissions and long-term nursing home placement. A total of 1,083 Medicare beneficiaries with dementia were enrolled in the program and were followed for three years. The study compared them to a similar group of patients living in the same ZIP codes who did not participate in the program.

 MedicalResearch.com: What are the main findings? 

Response: We found that a comprehensive, coordinated care program for people with dementia and their caregivers significantly decreased the likelihood that the patients would enter a nursing home. The most striking finding was that patients enrolled in the program reduced their risk of entering a nursing home by 40 percent. The study also showed that the program saved Medicare money ($601 per patient, per quarter, for a total of $2404 a year) and was cost-neutral after accounting for program costs. 

MedicalResearch.com: What should readers take away from your report? 

Response: The findings of this study show that a comprehensive, coordinated care program for persons with dementia can keep persons with dementia living in their homes in the community for longer without any additional cost to Medicare.

This study aligns with similar studies of collaborative care models for other chronic diseases, such as heart failure. It underscores that we need to be thinking differently about how we provide care to persons with chronic illnesses, like dementia. This study shows the benefit of a collaborative care model, where nurse practitioners and physicians work together to provide comprehensive dementia care. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research should test different models of care management for dementia—health-system based vs. community-based models—so we can better understand which models work best for which patients and how we can better implement and spread these models to people living with dementia who need better care.

The authors have no conflicts of interest to report.

Citation:

Jennings LA, Laffan AM, Schlissel AC, et al. Health Care Utilization and Cost Outcomes of a Comprehensive Dementia Care Program for Medicare Beneficiaries. JAMA Intern Med. Published online December 21, 2018. doi:10.1001/jamainternmed.2018.5579 

Dec 27, 2018 @ 11:38 pm 

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