title: Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.
abstract: OBJECTIVE
  Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services.
  
  
  METHODS
  This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses.
  
  
  RESULTS
  Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p < 0.001), lesser severity of dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites.
  
  
  CONCLUSIONS
  Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials.
authors.affiliation: School of Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Marwa
authors.initials: M
authors.lastname: Kaisey
authors.forename: Brian
authors.initials: B
authors.lastname: Mittman
authors.forename: Marjorie
authors.initials: M
authors.lastname: Pearson
authors.forename: Karen I
authors.initials: KI
authors.lastname: Connor
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
authors.forename: Stefanie D
authors.initials: SD
authors.lastname: Vassar
authors.forename: France T
authors.initials: FT
authors.lastname: Nguyen
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Vickrey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology; D003704:Dementia / Q000628:therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D010346:Patient Care Management; D058996:Quality Improvement / Q000458:organization & administration*