title: Collaborative care management reduces disparities in dementia care quality for caregivers with less education.
abstract: OBJECTIVE
  To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver.
  
  
  METHODS
  Analysis of data from a cluster-randomized controlled trial.
  
  
  METHODS
  Eighteen clinics in three healthcare organizations in southern California.
  
  
  METHODS
  Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver.
  
  
  METHODS
  Collaborative care management for dementia.
  
  
  METHODS
  Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants.
  
  
  RESULTS
  At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P < .001 for all three).
  
  
  CONCLUSIONS
  Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education.
authors: Division of General Internal Medicine and Health Services Research, University of California at Los Angeles, Los Angeles, California 90024, USA. abrown@mednet.ucla.edu
authors: Arleen F
authors: AF
authors: Brown
authors: Stefanie D
authors: SD
authors: Vassar
authors: Karen I
authors: KI
authors: Connor
authors: Barbara G
authors: BG
authors: Vickrey
mesh_terms: D000368:Aged; D002140:California; D017028:Caregivers / Q000193:education* / Q000592:standards; D003299:Cooperative Behavior; D003704:Dementia / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States