The economics of dementia-care mapping in nursing homes: a cluster-randomised controlled trial.
BACKGROUND
Dementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes.


METHODS
Dementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units.


RESULTS
34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0.05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0.02).


CONCLUSIONS
DCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they adopt the DCM method.


BACKGROUND
Dutch Trials Registry NTR2314.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Geertje
G
van de Ven
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Irena
I
Draskovic
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Elke
E
van Herpen
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Raymond T C M
RT
Koopmans
Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Rogier
R
Donders
Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, Groningen, The Netherlands.
Sytse U
SU
Zuidema
Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Eddy M M
EM
Adang
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Kalorama Foundation, Beek-Ubbergen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
Myrra J F J
MJ
Vernooij-Dassen
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000191:economics* / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009426:Netherlands; D009735:Nursing Homes / Q000191:economics*; D009740:Nursing Staff / Q000191:economics