title: Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program: A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans Affairs Medical Center.
abstract: Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides home-based dementia care and caregiver support for individuals with dementia and their family caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on a consultation basis. The objectives of this study were to describe the COACH program in its first 2 years of operation, assess alignment of program components with quality measures, report characteristics of program participants, and compare rates of placement outside the home with those of a nontreatment comparison group using a retrospective cohort design. Participants were community-dwelling individuals with dementia aged 65 and older who received primary care in the medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133), and a control group of dyads who were referred to the program and met clinical eligibility criteria but did not enroll (n = 29). Measures included alignment with Dementia Management Quality Measures and time to placement outside the home during 12 months of follow-up after referral to COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process measures identified using quality measures and that COACH delivers several other valuable services to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups (P = .99). The present study demonstrates the successful implementation of a home-based care coordination intervention for persons with dementia and their family caregivers that is strongly aligned with quality measures.
authors.affiliation: Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of Geriatrics, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Maria F
authors.initials: MF
authors.lastname: D'Souza
authors.affiliation: Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.
authors.forename: Judith
authors.initials: J
authors.lastname: Davagnino
authors.affiliation: Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of Geriatrics, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.|Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Center for the Study of Aging, School of Medicine, Duke University, Durham, North Carolina.
authors.forename: S Nicole
authors.initials: SN
authors.lastname: Hastings
authors.affiliation: Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Center for the Study of Aging, School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.affiliation: Geriatric Psychiatry, Jewish Home of San Francisco, San Francisco, California.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kamholz
authors.affiliation: Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of Geriatrics, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Jack
authors.initials: J
authors.lastname: Twersky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D015331:Cohort Studies; D003704:Dementia / Q000628:therapy*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009657:North Carolina; D015397:Program Evaluation; D012944:Social Support; D014728:Veterans
keywords: behavioral and psychological symptoms of dementia; care coordination; caregiver support; dementia caregiving; quality measures