Outcomes for patients with dementia from the Cleveland Alzheimer's Managed Care Demonstration

Abstract

This investigation evaluates effects of care consultation delivered within a partnership between a managed health care system and Alzheimer's Association chapter. Care consultation is a multi-component telephone intervention in which Association staff work with patients and caregivers to identify personal strengths and resources within the family, health plan, and community. The primary hypothesis is that care consultation will decrease utilization of managed care services and improve psychosocial outcomes. A secondary modifying-effects hypothesis posits benefits will be greater for patients with more severe memory impairment. The sample is composed of managed care patients whose medical records indicate a diagnosis of dementia or memory loss. Patients were randomly assigned to an intervention group, which was offered care consultation in addition to usual managed care services, or to a control group, which was offered only usual managed care services. Data come from two in-person interviews with patients, and medical and administrative records. Results supporting the primary hypothesis show intervention group patients feel less embarrassed and isolated because of their memory problems and report less difficulty coping. Findings consistent with the modifying-effects hypothesis show intervention group patients with more severe impairment have fewer physician visits, are less likely to have an emergency department visit or hospital admission, are more satisfied with managed care services, and have decreased depression and strain.

Acknowledgements

This demonstration was funded by grants from The Cleveland Foundation, The Elisabeth Severance Prentiss Foundation, The Abington Foundation, The Eva L. and Joseph M. Bruening Foundation, the Alzheimer's Association, The Laura Horn Memorial Trust, Ohio Department of Aging, and Administration on Aging. The authors would like to thank the staff of Kaiser Permanente of Ohio and the Cleveland Area Alzheimer's Association for developing and implementing the intervention with special thanks to Linda Choken, Wendy Dahar, Diane Graham, Dr. Kathleen Grieser, Lynn Hodge, Dr. Alan Khoury, Katie Maslow, Ann Scott, and John Wallin. The authors also would like to thank demonstration co-investigators Dr. Richard Fortinsky, University of Connecticut, Department of Family Medicine and Dr. Kathleen Smyth, Case Western Reserve University, University Memory and Aging Center.