Dementia Care Management in an Underserved Community

The Comparative Effectiveness of Two Different Approaches

Published In: Journal of Aging and Health, 2015

Posted on RAND.org on February 19, 2015

by Joshua Chodosh, Benjamin Colaiaco, Karen Connor, Dennis W. Cope, Harry H. Liu, David A. Ganz, Mark Jason Richman, Debra Cherry, Joseph Moshe Blank, Raquel del Carbone, Sheldon Mark Wolf, Barbara Vickrey

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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.

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