Caregivers' utilization of health services: results from the Medicare Alzheimer's Disease Demonstration, Illinois site.
OBJECTIVE
The purpose of this study is to examine the effect of the Medicare Alzheimer's Disease Demonstration and Evaluation (MADDE) conducted in Illinois on the use of health services and Medicare expenditures by caregivers of persons with dementia.


METHODS
Prospective randomized clinical trial.


METHODS
The MADDE (1989-1994), Illinois site.


METHODS
A cohort of 412 Medicare-eligible caregivers of persons with dementia.


METHODS
Medicare claims files provided data on the number of hospitalizations, hospital bed days, emergency department visits, and total Medicare Part A expenditures.


RESULTS
After adjustment for baseline variables, the caregivers in the treatment group, when compared with those in the comparison group, had a lower likelihood of any hospitalization during the study period (odds ratio 0.58 (95% confidence interval (CI)=0.35-0.97), P= .037) and a reduced, but not significant, likelihood of emergency department use (odds ratio 0.66 (95% CI=0.40-1.08), P= .095). For those who were hospitalized, there were no significant differences between the treatment and comparison group caregivers in the number of hospitalizations, hospital length of stay, or Medicare payments.


CONCLUSIONS
These results suggest that enhanced chronic illness case management directed at persons with dementia and their caregivers can reduce the need for acute hospital care.
Shelton
P
P
Outcomes/Performance and Improvement, Coordinated Care Services, Mahomet, Illinois 61853, USA.
Schraeder
C
C
Dworak
D
D
Fraser
C
C
Sager
M A
MA
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data*; D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D016344:Medicare Part A / Q000191:economics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D015397:Program Evaluation / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis