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D-CARE: The Dementia Care Study: Design of a Pragmatic Trial of the Effectiveness and Cost Effectiveness of Health System-Based Versus Community-Based Dementia Care Versus Usual Dementia Care.
Reuben, David B; Gill, Thomas M; Stevens, Alan; Williamson, Jeff; Volpi, Elena; Lichtenstein, Maya; Jennings, Lee A; Tan, Zaldy; Evertson, Leslie; Bass, David; Weitzman, Lisa; Carnie, Martie; Wilson, Nancy; Araujo, Katy; Charpentier, Peter; Meng, Can; Greene, Erich J; Dziura, James; Liu, Jodi; Unger, Erin; Yang, Mia; Currie, Katherine; Lenoir, Kristin M; Green, Aval-NaʼRee S; Abraham, Sitara; Vernon, Ashley; Samper-Ternent, Rafael; Raji, Mukaila; Hirst, Roxana M; Galloway, Rebecca; Finney, Glen R; Ladd, Ilene; Rahm, Alanna Kulchak; Borek, Pamela; Peduzzi, Peter.
Afiliação
  • Reuben DB; Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
  • Gill TM; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Stevens A; Department of Medicine, Baylor Scott & White Health, Temple, Texas, USA.
  • Williamson J; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
  • Volpi E; Department of Internal Medicine, Division of Geriatrics, University of Texas, Medical Branch, Galveston, Texas, USA.
  • Lichtenstein M; Department of Neurology, Geisinger Health, Wilkes Barre, Pennsylvania, USA.
  • Jennings LA; Department of Medicien, Reynolds Section of Geriatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
  • Tan Z; Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
  • Evertson L; Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
  • Bass D; Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio, USA.
  • Weitzman L; Center for Research and Education, Benjamin Rose Institute on Aging, Cleveland, Ohio, USA.
  • Carnie M; Center for Patients and Families, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Wilson N; Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
  • Araujo K; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Charpentier P; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Meng C; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Greene EJ; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Dziura J; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
  • Liu J; Pardee RAND Graduate School, Santa Monica, California, USA.
  • Unger E; Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
  • Yang M; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
  • Currie K; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
  • Lenoir KM; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
  • Green AS; Department of Medicine, Baylor Scott & White Health, Temple, Texas, USA.
  • Abraham S; Department of Medicine, Baylor Scott & White Health, Temple, Texas, USA.
  • Vernon A; Department of Medicine, Baylor Scott & White Health, Temple, Texas, USA.
  • Samper-Ternent R; Department of Internal Medicine, Division of Geriatrics, University of Texas, Medical Branch, Galveston, Texas, USA.
  • Raji M; Department of Internal Medicine, Division of Geriatrics, University of Texas, Medical Branch, Galveston, Texas, USA.
  • Hirst RM; Department of Internal Medicine, Division of Geriatrics, University of Texas, Medical Branch, Galveston, Texas, USA.
  • Galloway R; Department of Internal Medicine, Division of Geriatrics, University of Texas, Medical Branch, Galveston, Texas, USA.
  • Finney GR; Department of Neurology, Geisinger Health, Wilkes Barre, Pennsylvania, USA.
  • Ladd I; Department of Neurology, Geisinger Health, Wilkes Barre, Pennsylvania, USA.
  • Rahm AK; Department of Neurology, Geisinger Health, Wilkes Barre, Pennsylvania, USA.
  • Borek P; Department of Neurology, Geisinger Health, Wilkes Barre, Pennsylvania, USA.
  • Peduzzi P; Department of Internal Medicine, Section of Geriatrics, Yale University, New Haven, Connecticut, USA.
J Am Geriatr Soc ; 68(11): 2492-2499, 2020 11.
Article em En | MEDLINE | ID: mdl-32949145
ABSTRACT
BACKGROUND/

OBJECTIVES:

Although several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown.

DESIGN:

Pragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad.

SETTING:

Four clinical trial sites (CTSs) based in academic and clinical health systems.

PARTICIPANTS:

A total of 2,150 English- or Spanish-speaking PWD who are not receiving hospice or residing in a nursing home and their caregivers.

INTERVENTIONS:

Eighteen months of (1) HSDC provided by a nurse practitioner or physician's assistant dementia care specialist who works within the health system, or (2) CBDC provided by a social worker or nurse care consultant who works at a community-based organization, or (3) UC with as needed referral to the Alzheimer's Association Helpline. MEASUREMENTS Primary

outcomes:

PWD behavioral symptoms and caregiver distress as measured by the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity and Modified Caregiver Strain Index scales. SECONDARY

OUTCOMES:

NPI-Q Distress, caregiver unmet needs and confidence, and caregiver depressive symptoms. Tertiary

outcomes:

PWD long-term nursing home placement rates, caregiver-reported PWD functional status, cognition, goal attainment, "time spent at home," Dementia Burden Scale-Caregiver, a composite measure of clinical benefit, Quality of Life of persons with dementia, Positive Aspects of Caregiving, and cost effectiveness using intervention costs and Medicare claims.

RESULTS:

The results will be reported in the spring of 2024.

CONCLUSION:

D-CARE will address whether emphasis on clinical support and tighter integration with other medical services has greater benefit than emphasis on social support that is tied more closely to community resources. It will also assess the effectiveness of both interventions compared with UC and will evaluate the cost effectiveness of each intervention.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Serviços de Saúde Comunitária / Assistência Integral à Saúde / Doença de Alzheimer / Sobrecarga do Cuidador Tipo de estudo: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Qualitative_research Limite: Aged / Female / Humans / Male Idioma: En Revista: J Am Geriatr Soc Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
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PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Serviços de Saúde Comunitária / Assistência Integral à Saúde / Doença de Alzheimer / Sobrecarga do Cuidador Tipo de estudo: Clinical_trials / Diagnostic_studies / Health_economic_evaluation / Qualitative_research Limite: Aged / Female / Humans / Male Idioma: En Revista: J Am Geriatr Soc Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos