Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia

Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effective...

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Published inDementia and geriatric cognitive disorders Vol. 49; no. 6; p. 598
Main Authors Ha, Ngoc Huong Lien, Yap Lin Kiat, Philip, Nicholas, Sean Olivia, Chan, Ivana, Wee, Shiou Liang
Format Journal Article
LanguageEnglish
Published Switzerland 01.04.2021
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Abstract Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita. CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alz-heimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0. CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.
AbstractList Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of person-centred care, has been shown to maintain quality of life (QOL) in PWDs and caregivers, a lack of service integration can hinder effectiveness. CARITAS, an integrated care initiative provided through a hospital-community care partnership, endeavours to provide person-centred dementia care through ambulatory clinic consults, case management, patient and caregiver engagement, and support. We evaluated CARITAS' clinical outcomes and cost-effectiveness with a naturalistic cross-sectional within-subject design. We assessed patients' function, QOL, and behavioural problems post-intervention. We estimated CARITAS' cost-effectiveness from a patient's perspective, benchmarking it against other dementia treatments and Singapore's Gross Domestic Product (GDP) per capita. CARITAS care significantly improved health utility (p < 0.001), reduced caregiver burden (p < 0.001), and improved PWDs' behavioural problems (p < 0.001) related to "memory" (p < 0.001), "disruption" (p = 0.017), and "depression" (p < 0.001). CARITAS' benefits (dRMBPC = 0.357, dEQ5D index = 0.328, dZBI = 0.361) were comparable to those of other pharmacological and non-pharmacological interventions for dementia. CARITAS costs SG$133,056.69 per quality-adjusted life years gain, yielding an incremental cost-effectiveness ratio of 1.31 and 1.49 against the cost of donepezil in patients with mild Alz-heimer's disease and Singapore's GDP per capita in 2019, respectively, falling within the cost-effectiveness threshold of 1.0-3.0. CARITAS integrated dementia care is a cost-effective intervention that showed promising outcomes for PWDs and their caregivers.
Author Chan, Ivana
Ha, Ngoc Huong Lien
Nicholas, Sean Olivia
Yap Lin Kiat, Philip
Wee, Shiou Liang
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  givenname: Philip
  surname: Yap Lin Kiat
  fullname: Yap Lin Kiat, Philip
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  organization: Geriatric Education and Research Institute, Singapore, Singapore
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  givenname: Shiou Liang
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  fullname: Wee, Shiou Liang
  organization: Program in Health Services and System Research, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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crossref_primary_10_3389_fpsyg_2023_1095616
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crossref_primary_10_1016_j_archger_2021_104471
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Keywords Care management
Integrated care
Programme evaluation
Outcomes
Dementia
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Snippet Living with dementia is challenging for persons with dementia (PWDs) and their families. Although multi-component intervention, underscored by the ethos of...
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Title Evaluating the Outcomes of a Hospital-to-Community Model of Integrated Care for Dementia
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