Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use

作者：Katherine L. Possin, Jennifer Merrilees, Sarah Dulaney, Stephen J. Bonasera, Winston Chiong, Kirby Lee, Sarah Hooper, Isabel Elaine Allen, Tamara Braley, Alissa Bernstein Sideman, Talita D’Aguiar Rosa, Krista L. Harrison, Hailey Begert-Hellings, John Kornak, James G. Kahn, Georges Naasan, Serggio Lanata, Amy Clark, Anna Chodos, Rosalie Gearhart, Christine S. Ritchie, Bruce L. Miller · 发表于：JAMA Internal Medicine · 年份：2019 · DOI：10.1001/jamainternmed.2019.4101 · 被引用次数：273 · 研究领域：Dementia and Cognitive Impairment Research、Geriatric Care and Nursing Homes、Palliative Care and End-of-Life Issues

Importance: Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. Objective: To determine whether the Care Ecosystem is effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care. Design, Setting, and Participants: A single-blind, randomized clinical trial with a pragmatic design was conducted among PWDs and their caregivers. Each PWD-caregiver dyad was enrolled for 12 months between March 20, 2015, and February 28, 2017. Data were collected until March 5, 2018. Study interventions and assessments were administered over the telephone and internet by clinical and research teams in San Francisco, California, and Omaha, Nebraska. Of 2585 referred or volunteer PWD-caregiver dyads in California, Iowa, or Nebraska, 780 met eligibility criteria and were enrolled. A total of 512 PWD-caregiver dyads were randomized to receive care through the Care Ecosystem and 268 dyads to receive usual care. All eligible PWDs had a dementia diagnosis; were enrolled or eligible for enrollment in Medicare or Medicaid; and spoke English, Spanish, or Cantonese. Analyses were intention-to-treat. Intervention: Telephone-based collaborative dementia care was delivered by a trained care team navigator, who provided education, supp...