The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial.
BACKGROUND
Adherence to dementia guidelines is poor despite evidence that some guideline recommendations can improve symptoms and delay institutionalization of patients.


OBJECTIVE
To test the effectiveness of a dementia guideline-based disease management program on quality of care and outcomes for patients with dementia.


METHODS
Clinic-level, cluster randomized, controlled trial.


METHODS
3 health care organizations collaborating with 3 community agencies in southern California.


METHODS
18 primary care clinics and 408 patients with dementia age 65 years or older paired with 408 informal caregivers.


METHODS
Disease management program led by care managers and provided to 238 patient-caregiver pairs at 9 intervention clinics for more than 12 months.


METHODS
Adherence to 23 guideline recommendations (primary outcome) and receipt of community resources and patient and caregiver health and quality-of-care measures (secondary outcomes).


RESULTS
The mean percentage of per-patient guideline recommendations to which care was adherent was significantly higher in the intervention group than in the usual care group (63.9% vs. 32.9%, respectively; adjusted difference, 30.1% [95% CI, 25.2% to 34.9%]; P < 0.001). Participants who received the intervention had higher care quality on 21 of 23 guidelines (P < or = 0.013 for all), and higher proportions received community agency assistance (P < or = 0.03) than those who received usual care. Patient health-related quality of life, overall quality of patient care, caregiving quality, social support, and level of unmet caregiving assistance needs were better for participants in the intervention group than for those in the usual care group (P < 0.05 for all). Caregiver health-related quality of life did not differ between the 2 groups.


CONCLUSIONS
Participants were well-educated, were predominantly white, had a usual source of care, and were not institutionalized. Generalizability to other patients and geographic regions is unknown. Also, costs of a care management program under fee-for-service reimbursement may impede adoption.


CONCLUSIONS
A dementia guideline-based disease management program led to substantial improvements in quality of care for patients with dementia. Current Controlled Trials identifier: ISRCTN72577751.
Vickrey
Barbara G
BG
Department of Neurology, University of California, Los Angeles, VA Greater Los Angeles Healthcare System, Los Angeles, California 90095-1769, USA. bvickrey@ucla.edu
Mittman
Brian S
BS
Connor
Karen I
KI
Pearson
Marjorie L
ML
Della Penna
Richard D
RD
Ganiats
Theodore G
TG
Demonte
Robert W
RW
Chodosh
Joshua
J
Cui
Xinping
X
Vassar
Stefanie
S
Duan
Naihua
N
Lee
Martin
M
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017028:Caregivers / Q000592:standards*; D003153:Community Health Services / Q000592:standards*; D003704:Dementia / Q000628:therapy*; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*