Variations in Costs of a Collaborative Care Model for Dementia

作者：Talita D’Aguiar Rosa, Katherine L. Possin, Alissa Bernstein Sideman, Jennifer Merrilees, Sarah Dulaney, Jéssica Yumi Matuoka, Kirby P. Lee, Winston Chiong, Stephen J. Bonasera, Krista L. Harrison, James G. Kahn · 发表于：Journal of the American Geriatrics Society · 年份：2019 · DOI：10.1111/jgs.16076 · 被引用次数：25 · 研究领域：Geriatric Care and Nursing Homes、Palliative Care and End-of-Life Issues、Interprofessional Education and Collaboration

OBJECTIVES: Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program. DESIGN: We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017. SETTING: The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC). PARTICIPANTS: Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants. INTERVENTION: A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management. MEASUREMENTS: We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs. RESULTS: Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We esti...