ABSTRACT
OBJECTIVE: Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance? DESIGN: Cross-sectional, multi-level study. METHOD: The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves. RESULTS: The mean costs of the total curative care per patient were 3,092 - 6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (2,884 - 3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7% vs. 0.4%). CONCLUSION: The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.
ABSTRACT
OBJECTIVE: This study aimed to compare dietary intake of older people with dementia receiving day care at regular day care facilities (RDCFs) or at so-called green care farms (GCFs). DESIGN AND SETTINGS: A comparative cross-sectional study was performed at 10 GCFs and 10 RDCFs in the Netherlands. PARTICIPANTS: 30 subjects from GCFs and 23 subjects from RDCFs, aged 65 years or over, were included in the study. Subjects from GCFs were mostly married males who were aged younger than the subjects from RDCFs who were mostly widowed females. MEASUREMENTS: Dietary intake of the subjects was observed and/or recorded both at home and during their time at the day care facility. RESULTS: In the GCF group, average total energy intake was significantly higher than in the RDCF group (8.8 MJ/d vs. 7.2 MJ/d). Also total carbohydrates and protein intakes were higher in the GCF group than in the RDCF group (with 257 g/d vs. 204 g/d, and 76 g/d vs. 65 g/d respectively). In addition, average total fluid intake was significantly higher in the GCF group than in the RDCF group (2577 g/d vs. 1973 g/d). Multiple linear regression analyses revealed that after taking possible confounders into account, day care type was still significantly related to the intake of energy, carbohydrates and fluids. CONCLUSION: This study suggests beneficial effects of this new type of day care on dietary intake by community-dwelling older people with dementia.
