Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial

• Published in: Health services research Vol. 53; no. 1; pp. 556 - 579
• Main Authors: Amjad, Halima, Wong, Stephanie K., Roth, David L., Huang, Jin, Willink, Amber, Black, Betty S., Johnston, Deirdre, Rabins, Peter V., Gitlin, Laura N., Lyketsos, Constantine G., Samus, Quincy M.
• Format: Journal Article
• Language: English
• Published: United States Health Research and Educational Trust 01.02.2018; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: Acute services; Adults; Aged; Aged, 80 and over; Ambulatory care facilities; Analysis; Behavior management; care coordination; Care coordinators; Case Management - organization & administration; Case Management - statistics & numerical data; Clinics; Cognition disorders; Cognitive ability; Cognitive disorders; Cognitive impairment; Communities; Community Health Services - organization & administration; Community Health Services - statistics & numerical data; Community mental health services; Community services; Community-based programs; Continuity of Patient Care - organization & administration; Continuity of Patient Care - statistics & numerical data; Coordination; Coordinators; Data collection; Delirium; Dementia; Dementia - epidemiology; Dementia disorders; Efficacy; Extraction; Facilities and Services Utilization - statistics & numerical data; Falls; Female; Health services utilization; Home Care Services - organization & administration; Home Care Services - statistics & numerical data; Hospitalization; Humans; Inpatient care; Interdisciplinary aspects; Intervention; Male; Maryland; Medical care; Medical care utilization; Medicine; Mental disorders; Mental health; Mental health services; Older people; Patient Acceptance of Health Care - statistics & numerical data; Patient Care Team; Primary Care and Chronic Disease Management; Single-Blind Method; Support services; Utilization; Maryland; care coordination; Dementia
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/1475-6773.12647

Objective To investigate effects of a novel dementia care coordination program on health services utilization. Data Sources/Study Setting A total of 303 community‐dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008–2011). Study Design Single‐blind RCT evaluating efficacy of an 18‐month care coordination intervention delivered through community‐based nonclinical care coordinators, supported by an interdisciplinary clinical team. Data Collection/Extraction Methods Study partners reported acute care/inpatient, outpatient, and home‐ and community‐based service utilization at baseline, 9, and 18 months. Principal Findings From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community‐based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). Conclusions While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia‐related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use.