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1.
Aging Ment Health ; 28(3): 422-426, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37622184

RESUMO

OBJECTIVE: This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). METHODS: A total of 237 persons with dementia and their caregivers were included from a previous observational study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual's self or proxy-reported met needs on their own HRQOL (actor effects), and an individual's self or proxy-reported met needs on the other dyad member's HRQOL (partner effects). RESULTS: The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = -0.200, p < 0.001), and the HRQOL of informal caregivers (partner effect b = -0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = -0.105, p < 0.001) but not the person living with dementia's HRQOL (-0.025, p = 0.375). CONCLUSION: Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members' HRQOL.


Assuntos
Cuidadores , Demência , Humanos , Idoso , Qualidade de Vida , Autorrelato , Estudos Transversais
2.
Eur J Health Econ ; 24(6): 951-965, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36161553

RESUMO

INTRODUCTION: For the analysis of clinical effects, multiple imputation (MI) of missing data were shown to be unnecessary when using longitudinal linear mixed-models (LLM). It remains unclear whether this also applies to trial-based economic evaluations. Therefore, this study aimed to assess whether MI is required prior to LLM when analyzing longitudinal cost and effect data. METHODS: Two-thousand complete datasets were simulated containing five time points. Incomplete datasets were generated with 10, 25, and 50% missing data in follow-up costs and effects, assuming a Missing At Random (MAR) mechanism. Six different strategies were compared using empirical bias (EB), root-mean-squared error (RMSE), and coverage rate (CR). These strategies were: LLM alone (LLM) and MI with LLM (MI-LLM), and, as reference strategies, mean imputation with LLM (M-LLM), seemingly unrelated regression alone (SUR-CCA), MI with SUR (MI-SUR), and mean imputation with SUR (M-SUR). RESULTS: For costs and effects, LLM, MI-LLM, and MI-SUR performed better than M-LLM, SUR-CCA, and M-SUR, with smaller EBs and RMSEs as well as CRs closers to nominal levels. However, even though LLM, MI-LLM and MI-SUR performed equally well for effects, MI-LLM and MI-SUR were found to perform better than LLM for costs at 10 and 25% missing data. At 50% missing data, all strategies resulted in relatively high EBs and RMSEs for costs. CONCLUSION: LLM should be combined with MI when analyzing trial-based economic evaluation data. MI-SUR is more efficient and can also be used, but then an average intervention effect over time cannot be estimated.


Assuntos
Análise Custo-Benefício , Humanos , Modelos Lineares , Simulação por Computador
3.
PLoS One ; 17(1): e0263130, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35085361

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of the Cardiac Care Bridge (CCB) nurse-led transitional care program in older (≥70 years) cardiac patients compared to usual care. METHODS: The intervention group (n = 153) received the CCB program consisting of case management, disease management and home-based cardiac rehabilitation in the transition from hospital to home on top of usual care and was compared with the usual care group (n = 153). Outcomes included a composite measure of first all-cause unplanned hospital readmission or mortality, Quality Adjusted Life Years (QALYs) and societal costs within six months follow-up. Missing data were imputed using multiple imputation. Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated by using bootstrapped seemingly unrelated regression. RESULTS: No significant between group differences in the composite outcome of readmission or mortality nor in societal costs were observed. QALYs were statistically significantly lower in the intervention group, mean difference -0.03 (95% CI: -0.07; -0.02). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.31 at a Willingness To Pay (WTP) of €0,00 and 0.14 at a WTP of €50,000 per composite outcome prevented and 0.32 and 0.21, respectively per QALY gained. CONCLUSION: The CCB program was on average more expensive and less effective compared to usual care, indicating that the CCB program is dominated by usual care. Therefore, the CCB program cannot be considered cost-effective compared to usual care.


Assuntos
Cardiopatias/economia , Cardiopatias/terapia , Qualidade de Vida , Cuidado Transicional/economia , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Humanos , Masculino
4.
PLoS One ; 15(11): e0241132, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147248

RESUMO

BACKGROUND: Norway instituted a Coordination Reform in 2012 aimed at maximizing time at home by providing in-home care through community services. Dying in a hospital can be highly stressful for patients and families. Persons with dementia are particularly vulnerable to negative outcomes in hospital. This study aims to describe changes in the proportion of older adults with and without dementia dying in nursing homes, home, hospital and other locations over an 11-year period covering the reform. METHODS AND FINDINGS: This is a repeated cross-sectional, population-level study using mortality data from the Norwegian Cause of Death Registry hosted by the Norwegian Institute of Public Health. Participants were Norwegian older adults 65 years or older with and without dementia who died from 2006 to 2017. The policy intervention was the 2012 Coordination Reform that increased care infrastructure into communities. The primary outcome was location of death listed as a nursing home, home, hospital or other location. The trend in the proportion of location of death, before and after the reform was estimated using an interrupted time-series analysis. All analyses were adjusted for sex and seasonality. Of the 417,862 older adult decedents, 61,940 (14.8%) had dementia identified on their death certificate. Nursing home deaths increased over time while hospital deaths decreased for the total population (adjusted Relative Risk Ratio (aRRR) 0.87, 95% CI 0.82-0.92) and persons with dementia (aRRR: 0.93, 95%CI 0.91-0.96) after reform implementation. CONCLUSION: This study provides evidence that the 2012 Coordination Reform was associated with decreased older adults dying in hospital and increased nursing home death; however, the number of people dying at home did not change.


Assuntos
Demência/mortalidade , Reforma dos Serviços de Saúde , Serviços de Assistência Domiciliar/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Estudos Transversais , Demência/terapia , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Análise de Séries Temporais Interrompida , Masculino , Noruega/epidemiologia , Sistema de Registros/estatística & dados numéricos , Seguridade Social , Assistência Terminal/organização & administração , Assistência Terminal/estatística & dados numéricos
5.
Alzheimers Dement ; 16(9): 1224-1233, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32729984

RESUMO

BACKGROUND: Most persons with dementia have multiple chronic conditions; however, it is unclear whether co-existing chronic conditions contribute to health-care use and cost. METHODS: Persons with dementia and ≥2 chronic conditions using the National Health and Aging Trends Study and Medicare claims data, 2011 to 2014. RESULTS: Chronic kidney disease and ischemic heart disease were significantly associated with increased adjusted risk ratios of annual hospitalizations, hospitalization costs, and direct medical costs. Depression, hypertension, and stroke or transient ischemic attack were associated with direct medical and societal costs, while atrial fibrillation was associated with increased hospital and direct medical costs. No chronic condition was associated with informal care costs. CONCLUSIONS: Among older adults with dementia, proactive and ambulatory care that includes informal caregivers along with primary and specialty providers, may offer promise to decrease use and costs for chronic kidney disease, ischemic heart disease, atrial fibrillation, depression, and hypertension.


Assuntos
Doença Crônica/economia , Efeitos Psicossociais da Doença , Demência/economia , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Feminino , Inquéritos Epidemiológicos , Cardiopatias/economia , Hospitalização/economia , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare , Estados Unidos
6.
BMJ Open ; 10(3): e033802, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234741

RESUMO

INTRODUCTION: Hospital admission in older adults with multiple chronic conditions is associated with unwanted outcomes like readmission, institutionalisation, functional decline and mortality. Providing acute care in the community and integrating effective components of care models might lead to a reduction in negative outcomes. Recently, the first geriatrician-led Acute Geriatric Community Hospital (AGCH) was introduced in the Netherlands. Care at the AGCH is focused on the treatment of acute diseases, comprehensive geriatric assessment, setting patient-led goals, early rehabilitation and streamlined transitions of care. METHODS AND ANALYSIS: This prospective cohort study will investigate the effectiveness of care delivery at the AGCH on patient outcomes by comparing AGCH patients to two historic cohorts of hospitalised patients. Propensity score matching will correct for potential population differences. The primary outcome is the 3-month unplanned readmission rate. Secondary outcomes include functional decline, institutionalisation, healthcare utilisation, occurrence of delirium or falls, health-related quality of life, mortality and patient satisfaction. Measurements will be conducted at admission, discharge and 1, 3 and 6 months after discharge. Furthermore, an economic evaluation and qualitative process evaluation to assess facilitators and barriers to implementation are planned. ETHICS AND DISSEMINATION: The study will be conducted according to the Declaration of Helsinki. The Medical Ethics Research Committee confirmed that the Medical Research Involving Human Subjects Act did not apply to this research project and official approval was not required. The findings of this study will be disseminated through public lectures, scientific conferences and journal publications. Furthermore, the findings of this study will aid in the implementation and financing of this concept (inter)nationally. TRIAL REGISTRATION NUMBER: NL7896; Pre-results.


Assuntos
Atividades Cotidianas , Atenção à Saúde/normas , Geriatria/normas , Hospitais Comunitários , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Países Baixos , Estudos Observacionais como Assunto , Estudos Prospectivos , Projetos de Pesquisa
7.
Am J Geriatr Psychiatry ; 28(3): 363-367, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31708379

RESUMO

OBJECTIVE: This study examined in a large sample of dementia caregiving dyads the associations between both partners' reports of unmet needs in persons with dementia (PwDs) and both partners' health-related quality of life (HRQOL). METHODS: This was a cross-sectional self-report survey of 521 community-dwelling dyads in a pragmatic trial in the Netherlands. The Camberwell Needs Assessment was used to measure PwDs' unmet needs. Both partners' self-reported their HRQOL using the EuroQol-5. RESULTS: Controlling for covariates, PwDs' self-reported greater unmet needs were significantly associated with PwDs' and caregivers' lower self-reported HRQOL (actor effect; b = -0.044, ß = -0.226, z = -3.588, p <0.001 and partner effect; b = -0.021, ß = -0.131, z = -2.154, p = 0.031). Caregivers' proxy reports were greater than PwDs' self-reported unmet needs (Δ=0.66,χ2(1)=55.881,p<.0001). CONCLUSION: Clinicians should use caution in relying on caregiver proxy reports of PwDs' needs and HQOL alone regarding healthcare decision making.


Assuntos
Demência/enfermagem , Avaliação das Necessidades/estatística & dados numéricos , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Vida Independente , Masculino , Países Baixos
8.
Am J Emerg Med ; 38(1): 127-131, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31337598

RESUMO

BACKGROUND: There is an increasing focus in the emergency department (ED) on addressing the needs of persons with cognitive impairment, most of whom have multiple chronic conditions. We investigated which common comorbidities among multimorbid persons with cognitive impairment conferred increased risk for ED treat and release utilization. METHODS: We examined the association of 16 chronic conditions on use of ED treat and release visit utilization among 1006 adults with cognitive impairment and ≥ 2 comorbidities using the nationally-representative National Health and Aging Trends Study merged with Fee-For-Service Medicare claims data, 2011-2015. RESULTS: At baseline, 28.5% had ≥6 conditions and 35.4% were ≥ 85 years old. After controlling for sex, age, race, education, urban-living, number of disabled activities of daily living, and sampling strata, we found significantly increased adjusted risk ratios (aRR) of ED treat and release visits for persons with depression (aRR 1.38 95% CI 1.15-1.65) representing 78/100 person-years, and osteoarthritis or rheumatoid arthritis (aRR 1.32 95% CI 1.12-1.57) representing 71/100 person-years. At baseline 93.9% had ≥1 informal caregiver and 69.7% had a caregiver that helped with medications or attended physician visits. CONCLUSION: These results show that multimorbid cognitively impaired older adults with depression or osteoarthritis or rheumatoid arthritis are at higher risk of ED treat and release visits. Future ED research with multimorbid cognitively impaired persons may explore behavioral aspects of depression and/or pain and flairs associated with osteoarthritis or rheumatoid arthritis, as well as the role of informal caregivers in the care of these conditions.


Assuntos
Doença Crônica/psicologia , Doença Crônica/terapia , Disfunção Cognitiva , Serviço Hospitalar de Emergência/estatística & dados numéricos , Multimorbidade , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/psicologia , Artrite Reumatoide/terapia , Utilização de Instalações e Serviços , Feminino , Humanos , Estudos Longitudinais , Masculino , Medicare , Osteoartrite/psicologia , Osteoartrite/terapia , Estados Unidos
9.
J Am Med Dir Assoc ; 20(10): 1300-1306.e1, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31056452

RESUMO

OBJECTIVES: After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs. DESIGN: Prospective multicenter cohort study (between October 2015 and June 2017). SETTING AND PARTICIPANTS: 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards. MEASUREMENTS: Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms. RESULTS: Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group. CONCLUSIONS/IMPLICATIONS: Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice.


Assuntos
Pessoas com Deficiência , Hospitalização , Cuidados Semi-Intensivos/economia , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Fragilidade , Humanos , Doença Iatrogênica , Modelos Logísticos , Masculino , Países Baixos , Estudos Prospectivos
10.
J Am Geriatr Soc ; 66(4): 766-772, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29521414

RESUMO

OBJECTIVES: To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years. DESIGN: Population-based complex survey design. SETTING: National Health and Aging Trends Study. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609). MEASUREMENTS: National estimates were generated using sampling weights. Sociodemographic characteristics, self-reported physician-diagnosed chronic conditions, six activities of daily living (ADL), and cognitive status were ascertained in annual in-person interviews. A joint model using group-based trajectory modeling was used to estimate the number of ADL disabilities and attrition probability. Multinomial logistic regression with survey weights was used to estimate the association between diabetes, heart disease, and dementia and resultant trajectories of disability, with the least disabled trajectory used as a reference. RESULTS: Three functional disability trajectories were identified: 26.9 million (76.3%) individuals with no disability and a constant study attrition of 14.3%, 4.9 million (13.9%) with mild and increasing disability and 12% attrition in 2012 and 27.2% in 2015, and 3.4 million (9.7%) with severe and increasing disability and 25.4% attrition in 2012 and 35% in 2015. Persons with possible dementia, possible dementia and diabetes, or possible dementia with diabetes and heart disease had significantly greater odds of being on the mild disability trajectory than those with no disability. Persons with probable dementia, representing more than 1.5 million persons, regardless of concurrent conditions, had significantly greater odds of being on the severe disability trajectory than on the no disability trajectory. CONCLUSIONS: Methods that generate national estimates and account for attrition and for multiple chronic conditions and cognitive status may be useful for health policy-makers to make decisions on care provisions and services.


Assuntos
Demência , Diabetes Mellitus , Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Cardiopatias , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Vida Independente , Masculino , Medicare/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
11.
PLoS One ; 12(4): e0175272, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28414806

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care. METHODS: We conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged ≥ 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders. RESULTS: There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference €1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained. CONCLUSION: The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.


Assuntos
Enfermagem em Saúde Comunitária/economia , Economia da Enfermagem , Serviços de Saúde para Idosos/economia , Cuidados de Enfermagem , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Análise Custo-Benefício , Pessoas com Deficiência , Feminino , Avaliação Geriátrica , Custos de Cuidados de Saúde , Humanos , Masculino , Modelos Econômicos , Modelos de Enfermagem , Países Baixos , Anos de Vida Ajustados por Qualidade de Vida
12.
Health Qual Life Outcomes ; 15(1): 45, 2017 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-28253865

RESUMO

BACKGROUND: As populations age, chronic geriatric conditions linked to progressive organ failure jeopardize health-related quality of life (HRQoL). Thus, this research assessed the validity and applicability of the EQ-5D (a common HRQoL instrument) across four major chronic geriatric conditions: hearing issues, joint damage, urinary incontinence, or dizziness with falls. METHODS: The study sample comprised 25,637 community-dwelling persons aged 65 years and older residing in the Netherlands (Data source: TOPICS-MDS, www.topics-mds.eu ). Floor and ceiling effects were examined. To assess convergent validity, random effects meta-correlations (Spearman's rho) were derived between individual EQ-5D domains and related survey items. To further examine construct validity, the association between sociodemographic characteristics and EQ-5D summary scores were assessed using linear mixed models. Outcomes were compared to the overall study population as well as a 'healthy' subgroup reporting no major chronic conditions. RESULTS: Whereas ceiling effects were observed in the overall study population and the 'healthy' subgroup, such was not the case in the geriatric condition subgroups. The majority of hypotheses regarding correlations between survey items and sociodemographic associations were supported. EQ-5D summary scores were lower in respondents who were older, female, widowed/single, lower educated, and living alone. Increasing co-morbidity had a clear negative effect on EQ-5D scores. CONCLUSION: This study supported the construct validity of the EQ-5D across four major geriatric conditions. For older persons who are generally healthy, i.e. reporting few to no chronic conditions, the EQ-5D confers poor discriminative ability due to ceiling effects. Although the overall dataset initially suggested poor discriminative ability for the EQ-5D, such was not the case within subgroups presenting with major geriatric conditions.


Assuntos
Atividades Cotidianas/psicologia , Avaliação Geriátrica/métodos , Indicadores Básicos de Saúde , Qualidade de Vida/psicologia , Inquéritos e Questionários/normas , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Países Baixos , Reprodutibilidade dos Testes
13.
Tijdschr Gerontol Geriatr ; 47(6): 223-233, 2016 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-27848169

RESUMO

BACKGROUND: Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. AIM OF STUDY: Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. METHODS: A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). RESULTS: Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. CONCLUSION: The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.


Assuntos
Cuidadores , Administração de Caso/economia , Demência/enfermagem , Qualidade da Assistência à Saúde , Idoso , Estudos de Coortes , Análise Custo-Benefício , Feminino , Humanos , Vida Independente , Masculino , Países Baixos , Qualidade de Vida
14.
PLoS One ; 11(9): e0160908, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27655234

RESUMO

OBJECTIVES: The objective of this article was to compare the costs and cost-effectiveness of the two most prominent types of case management in the Netherlands (intensive case management and linkage models) against no access to case management (control group) for people with already diagnosed dementia and their informal caregivers. METHODS: The economic evaluation was conducted from a societal perspective embedded within a two year prospective, observational, controlled, cohort study with 521 informal caregivers and community-dwelling persons with dementia. Case management provided within one care organization (intensive case management model, ICMM), case management where care was provided by different care organizations within one region (Linkage model, LM), and a group with no access to case management (control) were compared. The economic evaluation related incremental costs to incremental effects regarding neuropsychiatric symptoms (NPI), psychological health of the informal caregiver (GHQ-12), and quality adjusted life years (QALY) of the person with dementia and informal caregiver. RESULTS: Inverse-propensity-score-weighted models showed no significant differences in clinical or total cost outcomes between the three groups. Informal care costs were significantly lower in the ICMM group compared to both other groups. Day center costs were significantly lower in the ICMM group compared to the control group. For all outcomes, the probability that the ICMM was cost-effective in comparison with LM and the control group was larger than 0.97 at a threshold ratio of 0 €/incremental unit of effect. CONCLUSION: This study provides preliminary evidence that the ICMM is cost-effective compared to the control group and the LM. However, the findings should be interpreted with caution since this study was not a randomized controlled trial.

15.
Eur J Health Econ ; 17(8): 939-950, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26497027

RESUMO

Cost and effect data often have missing data because economic evaluations are frequently added onto clinical studies where cost data are rarely the primary outcome. The objective of this article was to investigate which multiple imputation strategy is most appropriate to use for missing cost-effectiveness data in a randomized controlled trial. Three incomplete data sets were generated from a complete reference data set with 17, 35 and 50 % missing data in effects and costs. The strategies evaluated included complete case analysis (CCA), multiple imputation with predictive mean matching (MI-PMM), MI-PMM on log-transformed costs (log MI-PMM), and a two-step MI. Mean cost and effect estimates, standard errors and incremental net benefits were compared with the results of the analyses on the complete reference data set. The CCA, MI-PMM, and the two-step MI strategy diverged from the results for the reference data set when the amount of missing data increased. In contrast, the estimates of the Log MI-PMM strategy remained stable irrespective of the amount of missing data. MI provided better estimates than CCA in all scenarios. With low amounts of missing data the MI strategies appeared equivalent but we recommend using the log MI-PMM with missing data greater than 35 %.


Assuntos
Análise Custo-Benefício/métodos , Interpretação Estatística de Dados , Adulto , Feminino , Dependência de Heroína/tratamento farmacológico , Dependência de Heroína/economia , Humanos , Modelos Logísticos , Masculino , Metadona/economia , Metadona/uso terapêutico , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
PLoS One ; 9(4): e93372, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24710075

RESUMO

BACKGROUND: Self-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies. OBJECTIVE: To analyze older adults' self-report of healthcare utilization compared to data obtained from the general practitioners' (GP) electronic medical record (EMR) and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up. METHODS: A prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office. RESULTS: Overall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72-80), 55.8% had no disabilities in (instrumental) activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were substantial for 'hospitalizations' and 'GP home visits' at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58-0.68). Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05). Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001) and 18.9% had 2 or more hospital admissions (p<0.001) versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01) versus 18.6 of the participants who completed the study. CONCLUSIONS: Self-report of hospitalizations and GP home visits in a broadly 'healthy' community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will be used to support economic evaluation.


Assuntos
Atenção à Saúde , Hospitalização , Autorrelato , Inquéritos e Questionários , Idoso , Feminino , Seguimentos , Humanos , Masculino , Países Baixos , Estudos Prospectivos
17.
Trials ; 14: 305, 2013 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-24053631

RESUMO

BACKGROUND: Dementia imposes a heavy burden on health and social care systems as well as on family caregivers who provide a substantial portion of the care. Interventions that effectively support caregivers may prevent or delay patient institutionalization and hence be cost-effective. However, evidence about the cost-effectiveness of such interventions is scarce. The aim of this study was to evaluate the cost-effectiveness of a family meetings intervention for family caregivers of dementia patients in comparison with usual care over a period of 12 months. METHODS: The economic evaluation was conducted from a societal perspective alongside a randomized trial of 192 primary caregivers with community-dwelling dementia patients. Outcome measures included the Quality Adjusted Life-Years (QALY) of caregivers and patients and the incidence of depression and anxiety disorders in caregivers. Missing cost and effect data were imputed using multiple imputations. Bootstrapping was used to estimate uncertainty around the cost-differences and the incremental cost-effectiveness ratio (ICER). The bootstrapped cost-effect pairs were plotted on a cost-effectiveness plane and used to estimate cost-effectiveness curves. RESULTS: No significant differences in costs and effects between the groups were found. At 12 months, total costs per patient and primary caregiver dyad were substantial: €77,832 for the intervention group and €75,201 for the usual care group (adjusted mean difference per dyad €4,149, 95% CI -13,371 to 21,956, ICER 157,534). The main cost driver was informal care (66% of total costs), followed by patients' day treatment and costs of hospital and long-term care facility admissions (23%). Based on the cost-effectiveness acceptability curves, the maximum probability that the intervention was considered cost-effective in comparison with usual care reached 0.4 for the outcome QALY per patient-caregiver dyad and 0.6 for the caregivers' incidence of depression and/or anxiety disorders regardless of the willingness to pay. CONCLUSIONS: The annual costs of caring for a person with dementia were substantial with informal care being by far the largest contributor to the total societal costs. Based on this study, family meetings cannot be considered a cost-effective intervention strategy in comparison with usual care. TRIAL REGISTRATION: ISRCTN register, ISRCTN90163486.


Assuntos
Ansiedade/prevenção & controle , Cuidadores/psicologia , Aconselhamento , Demência/terapia , Depressão/prevenção & controle , Relações Familiares , Custos de Cuidados de Saúde , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/economia , Ansiedade/psicologia , Cuidadores/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Demência/diagnóstico , Demência/economia , Demência/psicologia , Depressão/diagnóstico , Depressão/economia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Apoio Social , Fatores de Tempo , Resultado do Tratamento
18.
PLoS One ; 7(5): e37444, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22655047

RESUMO

OBJECTIVE: The objective of this study was to evaluate the cost-effectiveness of a Multidisciplinary Integrated Care (MIC) model compared to Usual Care (UC) in Dutch residential homes. METHODS: The economic evaluation was conducted from a societal perspective alongside a 6 month, clustered, randomized controlled trial involving 10 Dutch residential homes. Outcome measures included a quality of care weighted sum score, functional health (COOP WONCA) and Quality Adjusted Life-Years (QALY). Missing cost and effect data were imputed using multiple imputation. Bootstrapping was used to analyze differences in costs and cost-effectiveness. RESULTS: The quality of care sum score in MIC was significantly higher than in UC. The other primary outcomes showed no significant differences between the MIC and UC. The costs of providing MIC were approximately €225 per patient. Total costs were €2,061 in the MIC group and €1,656 for the UC group (mean difference €405, 95% -13; 826). The probability that the MIC was cost-effective in comparison with UC was 0.95 or more for ceiling ratios larger than €129 regarding patient related quality of care. Cost-effectiveness planes showed that the MIC model was not cost-effective compared to UC for the other outcomes. INTERPRETATION: Clinical effect differences between the groups were small but quality of care was significantly improved in the MIC group. Short term costs for MIC were higher. Future studies should focus on longer term economic and clinical effects. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN11076857.


Assuntos
Habitação para Idosos/economia , Qualidade da Assistência à Saúde/economia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Humanos , Masculino , Países Baixos , Avaliação de Resultados em Cuidados de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida
19.
BMC Health Serv Res ; 12: 132, 2012 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-22640695

RESUMO

BACKGROUND: Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. DESIGN: Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant's perspective. The qualitative study uses purposive sampling methods to ensure a wide variation of respondents. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned. DISCUSSION: This study provides relevant insights into care processes, description of two case management models along with clinical and economic data from persons with dementia and caregivers to clarify important differences in two case management care models compared to usual care.


Assuntos
Cuidadores , Administração de Caso/organização & administração , Demência/enfermagem , Modelos Teóricos , Idoso , Administração de Caso/economia , Estudos de Coortes , Feminino , Humanos , Masculino , Países Baixos , Estudos Prospectivos , Projetos de Pesquisa , Inquéritos e Questionários
20.
Eur J Health Econ ; 12(1): 87-95, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20446014

RESUMO

This contribution seeks to measure preferences for health insurance of individuals with and without chronic conditions in two countries, Germany and the Netherlands. The objective is to test the presumption that preferences between these two subpopulations differ and to see whether having a chronic condition has a different influence on preferences depending on the country. The evidence comes from two Discrete Choice Experiments performed in 2005 (Germany) and 2006 (the Netherlands, right after a major health reform). Results point to an even more marked resistance against restrictions of physician choice among individuals with chronic conditions in both countries. Thus, the alleged beneficiaries of Disease Management Programs would have to be highly compensated for accepting the restrictions that go with them.


Assuntos
Comportamento de Escolha , Nível de Saúde , Seguro Saúde/estatística & dados numéricos , Doença Crônica , Alemanha , Humanos , Modelos Econométricos , Países Baixos
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