D-CARE: The Dementia Care Study: Design of a Pragmatic Trial of the Effectiveness and Cost Effectiveness of Health System-Based Versus Community-Based Dementia Care Versus Usual Dementia Care
| Autor: | Mukaila A. Raji, Peter Peduzzi, Katy L. B. Araujo, Martie Carnie, Ilene G. Ladd, Erin M Unger, Sitara Abraham, Rebecca V. Galloway, Maya Lichtenstein, Alan B. Stevens, Can Meng, Lisa Weitzman, Glen R. Finney, Alanna Kulchak Rahm, Rafael Samper-Ternent, Ashley H. Vernon, Elena Volpi, David M. Bass, Peter Charpentier, Nancy Wilson, Roxana M. Hirst, David B. Reuben, Jeff D. Williamson, Kristin M. Lenoir, Zaldy S. Tan, Jodi Liu, Erich J. Greene, Aval NaʼRee S. Green, James Dziura, Mia Yang, Thomas M. Gill, Lee A. Jennings, Katherine Currie, Leslie Chang Evertson, Pamela Borek |
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| Rok vydání: | 2020 |
| Předmět: |
Gerontology
Male Referral Cost effectiveness Cost-Benefit Analysis Psychological intervention Caregiver Burden Medical and Health Sciences Article 03 medical and health sciences Social support 0302 clinical medicine Quality of life (healthcare) Alzheimer Disease Pragmatic Clinical Trials as Topic medicine Dementia Humans Multicenter Studies as Topic 030212 general & internal medicine Community Health Services Aged business.industry Alzheimer's disease medicine.disease Quality Improvement care coordination Distress pragmatic trials Geriatrics Quality of Life Female Comprehensive Health Care Geriatrics and Gerontology business 030217 neurology & neurosurgery Neuropsychiatric Inventory Questionnaire dementia |
| Zdroj: | Journal of the American Geriatrics Society, vol 68, iss 11 J Am Geriatr Soc |
| Popis: | Author(s): Reuben, David B; Gill, Thomas M; Stevens, Alan; Williamson, Jeff; Volpi, Elena; Lichtenstein, Maya; Jennings, Lee A; Tan, Zaldy; Evertson, Leslie; Bass, David; Weitzman, Lisa; Carnie, Martie; Wilson, Nancy; Araujo, Katy; Charpentier, Peter; Meng, Can; Greene, Erich J; Dziura, James; Liu, Jodi; Unger, Erin; Yang, Mia; Currie, Katherine; Lenoir, Kristin M; Green, Aval-NaʼRee S; Abraham, Sitara; Vernon, Ashley; Samper-Ternent, Rafael; Raji, Mukaila; Hirst, Roxana M; Galloway, Rebecca; Finney, Glen R; Ladd, Ilene; Rahm, Alanna Kulchak; Borek, Pamela; Peduzzi, Peter | Abstract: Background/objectivesAlthough several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown.DesignPragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad.SettingFour clinical trial sites (CTSs) based in academic and clinical health systems.ParticipantsA total of 2,150 English- or Spanish-speaking PWD who are not receiving hospice or residing in a nursing home and their caregivers.InterventionsEighteen months of (1) HSDC provided by a nurse practitioner or physician's assistant dementia care specialist who works within the health system, or (2) CBDC provided by a social worker or nurse care consultant who works at a community-based organization, or (3) UC with as needed referral to the Alzheimer's Association Helpline.MeasurementsPrimary outcomes: PWD behavioral symptoms and caregiver distress as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity and Modified Caregiver Strain Index scales.Secondary outcomesNPI-Q Distress, caregiver unmet needs and confidence, and caregiver depressive symptoms. Tertiary outcomes: PWD long-term nursing home placement rates, caregiver-reported PWD functional status, cognition, goal attainment, "time spent at home," Dementia Burden Scale-Caregiver, a composite measure of clinical benefit, Quality of Life of persons with dementia, Positive Aspects of Caregiving, and cost effectiveness using intervention costs and Medicare claims.ResultsThe results will be reported in the spring of 2024.ConclusionD-CARE will address whether emphasis on clinical support and tighter integration with other medical services has greater benefit than emphasis on social support that is tied more closely to community resources. It will also assess the effectiveness of both interventions compared with UC and will evaluate the cost effectiveness of each intervention. |
| Databáze: | OpenAIRE |
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