Pragmatic Trial of the Effectiveness and Cost-Effectiveness of Dementia Care

痴呆症护理有效性和成本效益的务实试验

基本信息

批准号：
10665547
负责人：
DAVID B. REUBEN
金额：
$ 142.46万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-30 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10665547
关键词：
Adult Affect Aggressive behavior Agitation Alzheimer&apos s Disease Aspiration Pneumonia Award Behavioral Behavioral Symptoms Caregiver support Caregivers Caring Clinical Clinical effectiveness Communities Complex Consultations Cost Effectiveness Analysis Data Day center care Decision Making Deglutition Disorders Dementia Disease Disinhibition Distress Educational Materials Effectiveness Effectiveness of Interventions Elderly Electronic Health Record Evaluation Funding Hallucinations Health Professional Health system Healthcare Systems Home Immobilization Impaired cognition Insurance Carriers Intervention Location Managed Care Medical Medicare Mental Depression Nursing Homes Outcome Outcome Measure Participant Patient Education Patient-Focused Outcomes Patients Persons Physicians Pragmatic clinical trial Quality Indicator Quality of Care Reporting Research Research Institute Resources Services Site Time Uninsured Medical Expense United States active method arm base burnout caregiver strain caregiver stress clinical care community based care community organizations comparative comparative effectiveness compare effectiveness cost cost effective cost effectiveness dementia care falls health care service utilization improved innovation insight intervention cost mortality pragmatic trial primary outcome programs prototype provider adherence randomized, clinical trials relative effectiveness response satisfaction secondary outcome social treatment arm treatment as usual usual care arm

项目摘要

PROJECT SUMMARY In the United States, an estimated 5.5 million persons are affected by Alzheimer's disease, the most common type of dementia. The clinical manifestations of dementia are devastating and often lead to caregiver stress, burnout, and medical illnesses. Dementia is a prototype of a disorder with complex needs that span both the patient and caregiver, medical and social domains, and health system and community-based organizations. In response, several dementia care programs have been developed to more comprehensively meet the needs of patients and their caregivers, including those based within health care systems and those based in the community. These programs have been implemented at either single sites or on a relatively small scale; none has been replicated widely because of unanswered questions about effectiveness and cost-effectiveness. In November 2017, the Patient Centered Outcomes Research Institute (PCORI) approved a 4-site pragmatic clinical trial to compare the effectiveness of health-systems-based care (based on the UCLA Alzheimer's and Dementia Care program) with community-based care (based on the Benjamin Rose Institute Care Consultation program) on patient- and caregiver-reported outcome measures, including behavioral symptoms and caregiver distress (co-primary outcomes), and secondary outcomes of caregiver strain, unmet needs, and depression over 18-months. Because of PCORI's mandate, neither intervention will be compared to usual care (thus, only relative effectiveness can be determined). Nor will cost-effectiveness of either intervention be evaluated. The proposed research will add a third usual care (UC) arm and expand outcomes to include costs and health care utilization. This expansion will permit comparison of each of the intervention arms to current usual care, thereby providing multisite pragmatic randomized clinical trial evidence for effectiveness of the two active treatment arms. It will also allow evaluation of whether paying for such care will offset the costs and determination of which intervention is more cost effective. The study will also conduct exploratory analyses of tertiary outcomes of both interventions versus usual care including mortality, time spent at home, long-term nursing home placement, physician and patient/caregiver satisfaction and comparing all three groups on several types of utilization and out-of-pocket expenses. The study's questions are fundamental to planning for the clinical care of persons with dementia. They address both clinical effectiveness and cost-effectiveness. By answering these questions, clinicians, health systems, and insurers can make decisions about which programs to promote, scale and disseminate.

项目摘要在美国，估计有550万人受阿尔茨海默氏病的影响，这是最常见的痴呆症的类型。痴呆症的临床表现是毁灭性的，经常导致护理人员压力，倦怠和医学疾病。痴呆是具有复杂需求的疾病的原型患者和护理人员，医疗和社会领域以及卫生系统以及基于社区的组织。作为回应，已经制定了一些痴呆症护理计划，以更全面地满足需求患者及其护理人员，包括基于卫生保健系统的患者以及基于的患者社区。这些程序是在单个站点或相对较小的规模上实施的；没有任何由于有关有效性和成本效益的未解决问题，因此被广泛复制。 2017年11月，患者中心成果研究所（PCORI）批准了一个4点务实的临床试验比较基于健康系统的护理的有效性（根据UCLA阿尔茨海默氏症和痴呆症护理计划）通过基于社区的护理（基于本杰明玫瑰研究所的护理咨询计划）关于患者和护理人员报告的结果指标，包括行为症状和护理人员困扰（共同成果）和护理人员应变，未满足和抑郁的次要结果超过18个月。由于有PCORI的任务，都不会将干预措施与通常的护理进行比较（因此，可以确定相对有效性）。任何干预的成本效益也不会评估。拟议的研究将增加第三个常规护理（UC）部门并扩大结果，以包括成本和健康护理利用。这种扩展将允许将每个干预臂与当前通常的护理进行比较，从而为两者有效性提供多站点务实的随机临床试验证据治疗臂。它还将允许评估是否要支付此类护理会抵消成本和确定哪种干预措施更具成本效益。该研究还将进行探索性分析两种干预措施与通常的护理的三级成果，包括死亡率，在家中度过的时间，长期疗养院安置，医师和患者/照顾者满意度，并比较几种类型的利用和自付费用。该研究的问题是计划痴呆患者的临床护理的基础。他们解决临床有效性和成本效益。通过回答这些问题，临床医生，健康系统和保险公司可以决定要促进，扩展和传播哪些计划。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Dissemination of a successful dementia care program: Lessons from early adopters.

DOI：
10.1111/jgs.17887
发表时间：
2022-09
期刊：
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
影响因子：
6.3
作者：
Lees Haggerty, Kristin;Campetti, Randi;Stoeckle, Rebecca Jackson;Epstein-Lubow, Gary;Evertson, Leslie Chang;Spragens, Lynn;Serrano, Katherine Sy;Jennings, Lee A.;Reuben, David B.
通讯作者：
Reuben, David B.