The American journal of managed care · 2020
Effect of care coordination on patients with Alzheimer disease and their caregivers.
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Chen Brian, Cheng Xi, Streetman-Loy Blaiz, Hudson Matthew F, Jindal Dakshu, Hair Nicole
Аннотация
OBJECTIVES: To assess whether a care coordination and caregiver support intervention reduced use of acute medical services for both patients with Alzheimer disease (AD) and their caregivers.
STUDY DESIGN: Data were collected from patients with AD (n = 101) and their caregivers (n = 63) at Greenville Health System (now Prisma Health) in late 2012. Their data were linked to secondary all-payer claims data in South Carolina between 2011 and 2014.
METHODS: We conducted both a difference-in-differences regression and segmented regression analysis on the patients' health care utilization patterns pre- and post intervention. Propensity score matching identified a control group composed of nonintervention patients with AD in South Carolina (n = 928). We examined caregiver differences via t tests of differences in means.
RESULTS: Overall, the Memory Program did not reduce acute medical services. However, program participants experienced increases in total charges ($5243; 95% CI, $977-$9510) and in inpatient admissions with AD as a diagnosis (0.15; 95% CI, 0.029-0.272) but no increase in total all-cause charges. Intervention patients also had fewer emergency department (ED) visits (-0.0538; 95% CI, -0.102 to -0.0052) in some analyses. Finally, results suggest that post intervention, caregivers had half as many acute visits with depression as a diagnosis (from 0.22 to 0.11, difference of 0.11; 95% CI, -0.242 to 0.0198).
CONCLUSIONS: Although care coordination did not decrease overall acute health services use, coordination improved clinical documentation of patients' memory impairment. ED visits may have begun to decrease among patients. Finally, stress levels may have fallen among caregivers.
STUDY DESIGN: Data were collected from patients with AD (n = 101) and their caregivers (n = 63) at Greenville Health System (now Prisma Health) in late 2012. Their data were linked to secondary all-payer claims data in South Carolina between 2011 and 2014.
METHODS: We conducted both a difference-in-differences regression and segmented regression analysis on the patients' health care utilization patterns pre- and post intervention. Propensity score matching identified a control group composed of nonintervention patients with AD in South Carolina (n = 928). We examined caregiver differences via t tests of differences in means.
RESULTS: Overall, the Memory Program did not reduce acute medical services. However, program participants experienced increases in total charges ($5243; 95% CI, $977-$9510) and in inpatient admissions with AD as a diagnosis (0.15; 95% CI, 0.029-0.272) but no increase in total all-cause charges. Intervention patients also had fewer emergency department (ED) visits (-0.0538; 95% CI, -0.102 to -0.0052) in some analyses. Finally, results suggest that post intervention, caregivers had half as many acute visits with depression as a diagnosis (from 0.22 to 0.11, difference of 0.11; 95% CI, -0.242 to 0.0198).
CONCLUSIONS: Although care coordination did not decrease overall acute health services use, coordination improved clinical documentation of patients' memory impairment. ED visits may have begun to decrease among patients. Finally, stress levels may have fallen among caregivers.