Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 342
- 试验地点
- 2
- 主要终点
- Net cost offset (Medicare and Medicaid costs) of intervention
研究概览
简要总结
This Center for Medicare and Medicaid funded health care innovation award will implement the MIND at Home dementia care coordination program (called MIND at Home-Plus) through two community-based service agencies (Jewish Community Services, Johns Hopkins Home Care Group) to rapidly improve the ability of 600 dually eligible older adults with dementia in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs. MIND at Home participants receive an in-home needs assessment followed by up to 18 months of care coordination aimed at filling unmet needs.
详细描述
The demonstration project has 3 major tasks which will be implemented in concurrent, iterative phases: (1) implement MIND-Plus in 2 community-based health service agencies to rapidly improve the ability of 600 community-living dually eligible older adults with AD in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs associated with institutional care or hospitalization; (2) develop a replicable model for nationwide diffusion of the MIND program through a web-based certification package designed to prepare for implementation, build work-force capacity through training certification modules, and provide automated self-monitoring and quality improvement tools; and (3) develop and test a detailed payment model that takes a blended approach and includes provider care management fees with provider performance incentives from division of shared savings.
The investigators hypothesize that the MIND-Plus dementia care coordination program will (1) rapidly improve health & care quality and reduce total health care costs among Medicare-Medicaid dually eligible community-living older adults with AD, (2) drive health care system transformation by creating a new CMS financed benefit that would shift the hub of dementia care coordination to well-trained, dementia competent, interdisciplinary teams based in community health agencies, (3) achieve a sustainable payment model that produces significant net savings and incentives provider performance. This "shovel ready" community-based model is expected to improve outcomes within 6 months and save an estimated net-saving of $12.5 million by over 3 years.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •diagnosis of dementia
- •community living
- •has identified study partner willing to participate
- •english speaking
排除标准
- •situation at time of referral is a medical or mental health crisis
- •they plan to move out to another area or into a residential care facility in the next 6 months
- •they are currently on hospice.
研究组 & 干预措施
MIND at Home- Plus Intervention
MIND at Home-Plus is a home-based, care coordination that focuses on persons with dementia living at home and their family caregivers. Its goal is to help persons age in place safely while increasing quality of life. Delivered over 18 months, MIND-Plus systematically assesses and addresses unmet care needs of persons with dementia and their caregivers which are known to be linked to poor health and quality of life outcomes, and that put people at risk for long term care placement. The needs addressed in the MIND program cover a wide range of care domains, ranging from home and medication safety, to cognitive and behavior symptoms management, meaningful activities and legal considerations. The care team made up of a memory care coordinator, nurse, occupational therapist, and physician.
干预措施: MIND at Home-Plus Intervention (Behavioral)
结局指标
主要结局
Net cost offset (Medicare and Medicaid costs) of intervention
时间窗: 18 months
Estimated per beneficiary per year (PBPY) cost-offset of the MIND at Home-Plus program dementia care coordination program. Defined as the net financial benefit of the program to Medicare and Medicaid expenditures and calculated as the difference in the sum of all Medicare,Medicaid, and intervention costs between intervention group and the sum of all Medicare and Medicaid costs in matched comparison group from (baseline-18 months), adjusted from prior expenditures in the two year period prior to enrollment in the service program or selection into the comparison group.
次要结局
- Change in patient quality of life at 18 months(baseline to 18 months)
- Change in neuropsychiatric behavior symptoms at 18 months(baseline to 18 months)
- Hospitalization rates(18 months)
- 30 day re-hospitalization rates(18 months)
- Change in patient depression at 18 months(baseline to 18 months)
- Change in patient unmet dementia-related care needs(baseline to 18 months)
- Time to long term care placement or death(24 months)
- Change in caregiver depression at 18 months(baseline to 18 months)
- Change in caregiver quality of life at 18 months(baseline to 18 months)
- Change in caregiver unmet dementia-related care needs(baseline to 18 months)
- Emergency department rates(18 months)
- Change in caregiver subjective burden at 18 months(baseline to 18 months)
- Change in caregiver objective burden at 18 months(baseline to 18 months)