title: Dementia Care Management in an Underserved Community: The Comparative Effectiveness of Two Different Approaches.
abstract: OBJECTIVE
  To compare the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia.
  
  
  METHODS
  We randomized 151 patient-caregiver dyads from an underserved predominantly Latino community to two arms that shared a care management protocol but implemented in different formats: in-person visits at home and/or in the community plus telephone and mail, versus telephone and mail only. We compared between-arm caregiver burden and care-recipient problem behaviors (primary outcomes) and patient-caregiver dyad retention, care quality, health care utilization, and costs (secondary outcomes) at 6- and 12-months follow-up.
  
  
  RESULTS
  Care quality improved substantially over time in both arms. Caregiver burden, care-recipient problem behaviors, retention, and health care utilization did not differ across arms but the in-person program cost more to deliver.
  
  
  CONCLUSIONS
  Dementia care quality improved regardless of how care management was delivered; large differences in effectiveness or cost offsets were not detected.
authors: University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA JChodosh@mednet.ucla.edu.
authors: Joshua
authors: J
authors: Chodosh
authors: RAND Corporation, Santa Monica, CA, USA.
authors: Benjamin A
authors: BA
authors: Colaiaco
authors: University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA.
authors: Karen Ilene
authors: KI
authors: Connor
authors: University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA.
authors: Dennis Wesley
authors: DW
authors: Cope
authors: RAND Corporation, Santa Monica, CA, USA RAND Corporation, Boston, MA, USA.
authors: Hangsheng
authors: H
authors: Liu
authors: University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA.
authors: David Avram
authors: DA
authors: Ganz
authors: University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA.
authors: Mark Jason
authors: MJ
authors: Richman
authors: University of California, Los Angeles, USA Alzheimer's Association, Los Angeles, CA, USA University of Southern California, Los Angeles, USA.
authors: Debra Lynn
authors: DL
authors: Cherry
authors: University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA.
authors: Joseph Moshe
authors: JM
authors: Blank
authors: Veteran Affairs Greater Los Angeles Healthcare System, CA, USA.
authors: Raquel Del Pilar
authors: Rdel P
authors: Carbone
authors: University of California, Los Angeles, USA Olive View-UCLA Medical Center, Los Angeles, USA.
authors: Sheldon Mark
authors: SM
authors: Wolf
authors: University of California, Los Angeles, USA Veteran Affairs Greater Los Angeles Healthcare System, CA, USA RAND Corporation, Santa Monica, CA, USA.
authors: Barbara Grace
authors: BG
authors: Vickrey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D057186:Comparative Effectiveness Research; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D003704:Dementia / Q000191:economics / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data; D006792:House Calls / Q000191:economics; D006801:Humans; D015141:Los Angeles; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011177:Postal Service; D011787:Quality of Health Care / Q000706:statistics & numerical data; D013689:Telephone; D016896:Treatment Outcome
keywords: Alzheimer’s; care management; comparative effectiveness; dementia; health care delivery