The Impact of Ambulatory Dementia Care Models on Hospitalization of Persons Living With Dementia: A Systematic Review

Abstract

This systematic review presents an overview of the existing dementia care models in various ambulatory care settings under three categories (i.e., home- and community-based care models, partnership between health systems and community-based resources, and consultation models) and their impact on hospitalization among Persons Living with Dementia (PLWD). PRISMA guidelines were applied, and our search resulted in a total of 13 studies focusing on 11 care models. Seven studies reported that utilization of dementia care models was associated with a modest reduction in hospitalization among community-residing PLWD. Only two studies reported statistically significant results. Dementia care models that were utilized in specialty ambulatory care settings such as memory care showed more promising results than traditional primary care. To develop a better understanding of how dementia care models can be improved, future studies should explore how confounders (e.g., stage of dementia) influence hospitalization.

Keywords

dementia care models hospitalization community-residing PLWD ambulatory care settings

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References

AHRQ (2011). Quality indicator user Guide: Prevention quality indicators ( PQI ) composite measures. Rockville, MD: Agency for Healthcare Research and Quality.

Alzheimer’s Association (2019) Alzheimer’s disease facts and figures. Alzheimers and dementia. https://www.alz.org/alzheimers-dementia/10_signs.

Alzheimer’s Association (2020). 2020 Alzheimer’s disease facts and figures. Alzheimers Dementia, 15(3), 321-387. https://doi.org/10.1016/j.jalz.2019.01.010.

Amjad

Wong

S. K.

Roth

D. L.

Huang

Willink

Black

B. S.

Johnston

Rabins

P. V.

Gitlin

L. N.

Lyketsos

C. G.

Samus

Q. M.

Samus

Q. M.

(2018). Health services utilization in older adults with dementia receiving care coordination: The MIND at home trial. Health Services Research, 53(1), 556-579. https://doi.org/10.1111/1475-6773.12647.

Bass

D. M.

Clark

P. A.

Looman

W. J.

McCarthy

C. A.

Eckert

(2003). The cleveland Alzheimer’s managed care demonstration: outcomes after 12 months of implementation. The Gerontologist, 43(1), 73-85. https://doi.org/10.1093/geront/43.1.73.

Bass

D. M.

Judge

K. S.

Maslow

Wilson

N. L.

Morgan

R. O.

McCarthy

C. A.

Kunik

M. E.

(2015). Impact of the care coordination program “partners in dementia care” on veterans’ hospital admissions and emergency department visits. Alzheimer’s & Dementia, 1(1), 13-22. https://doi.org/10.1016/j.trci.2015.03.003.

Beydoun

M. A.

Beydoun

H. A.

Gamaldo

A. A.

Rostant

O. S.

Dore

G. A.

Zonderman

A. B.

Eid

S. M.

(2015). Nationwide inpatient prevalence, predictors, and outcomes of Alzheimer’s disease among dlder adults in the United States, 2002-2012. Journal of Alzheimer’s Disease, 48(2), 361-375. https://doi.org/10.3233/JAD-150228.

Boustani

Alder

C. A.

Solid

C. A.

Reuben

(2019). An alternative payment model to support widespread use of collaborative dementia care models. Health Affairs, 38(1), 54-59. https://doi.org/10.1377/hlthaff.2018.05154.

Callahan

C. M.

Boustani

M. A.

Unverzagt

F. W.

Austrom

M. G.

Damush

T. M.

Perkins

A. J.

Fultz

B.A.

Hui

S.L.

Counsell

S.R.

Hendrie

H. C.

(2006). Effectiveness of collaborative care for elderly adults with Alzheimer’s disease in primary care. JAMA, 295(18), 644-645. https://doi.org/10.1016/S1474-4422(06)70507-5.

10.

Clark

P. A.

Bass

D. M.

Looman

W. J.

McCarthy

C. A.

Eckert

(2004). Outcomes for patients with dementia from the cleveland Alzheimer’s managed care demonstration. Aging & Mental Health, 8(1), 40-51. https://doi.org/10.1080/13607860310001613329.

11.

Clevenger

C. K.

Cellar

Kovaleva

Medders

Hepburn

(2018). Integrated memory care clinic: Design, implementation, and initial results. Journal of the American Geriatrics Society, 66(12), 2401-2407. https://doi.org/10.1111/jgs.15528.

12.

Covinsky

K. E.

Palmer

R. M.

Fortinsky

R. H.

Counsell

S. R.

Stewart

A. L.

Kresevic

Landefeld

C. S.

(2003). Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. Journal of the American Geriatrics Society, 51(4), 451-458. https://doi.org/10.1046/j.1532-5415.2003.51152.x.

13.

Daaleman

T. P.

Ernecoff

N. C.

Kistler

C. E.

Reid

Reed

Hanson

L. C.

(2019). The impact of a community-based serious illness care program on healthcare utilization and patient care experience. Journal of the American Geriatrics Society, 67(4), 825-830. https://doi.org/10.1111/jgs.15814.

14.

Dorr

D. A.

Wilcox

A. B.

Brunker

C. P.

Burdon

R. E.

Donnelly

S. M.

(2008). The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors. Journal of the American Geriatrics Society, 56(12), 2195-2202. https://doi.org/10.1111/j.1532-5415.2008.02005.x.

15.

Duru

O. K.

Ettner

S. L.

Vassar

S. D.

Chodosh

Vickrey

B. G.

(2009). Cost evaluation of a coordinated care management intervention for dementia. The American Journal of Managed Care, 15(8), 521-528.

16.

Feng

Coots

L. A.

Kaganova

Wiener

J. M.

(2014). Hospital and ed use among medicare beneficiaries with dementia varies by setting and proximity to death. Health Affairs, 33(4), 683-690. https://doi.org/10.1377/hlthaff.2013.1179.

17.

Fingar

K. R.

Barrett

M. L.

Elixhauser

Stocks

Steiner

C. A.

(2015). Trends in potentially preventable inpatient hospital admissions and emergency department visits. Rockville, MD: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (pp. 1-20).

18.

Gao

Moran

Y. F.

Almenoff

P. L.

(2014). Predicting potentially avoidable hospitalizations. Medical Care, 52(2), 164-171. https://doi.org/10.1097/MLR.0000000000000041.

19.

Godard-Sebillotte

Le Berre

Schuster

Trottier

Vedel

(2019). Impact of health service interventions on acute hospital use in community-dwelling persons with dementia: A systematic literature review and meta-analysis. Plos One, 14(6), 1-18. https://doi.org/10.1371/journal.pone.0218426.

20.

Godard-Sebillotte

Strumpf

Sourial

Rochette

Pelletier

Vedel

(2021). Primary care continuity and potentially avoidable hospitalization in persons with dementia. Journal of the American Geriatrics Society, 69(5), 1208-1220. https://doi.org/10.1111/jgs.17049.

21.

Gual

Morandi

Pérez

L. M.

Brítez

Burbano

Man

Inzitari

(2018). Risk factors and outcomes of delirium in older patients admitted to postacute care with and without dementia. Dementia and Geriatric Cognitive Disorders, 45(1-2), 121-129. https://doi.org/10.1159/000485794.

22.

Hebert

L. E.

Weuve

Scherr

P. A.

Evans

D. A.

(2013). Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology, 80(19), 1778-1783. https://doi.org/10.1212/WNL.0b013e31828726f5.

23.

Higgins

J. P. T.

Altman

D. G.

Gøtzsche

P. C.

Jüni

Moher

Oxman

A. D.

Sterne

J. A. C.

(2011). The cochrane collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal, 343(7829), 1-9. https://doi.org/10.1136/bmj.d5928.

24.

Jennings

L. A.

Laffan

A. M.

Schlissel

A. C.

Colligan

Tan

Wenger

N. S.

Reuben

D. B.

(2019). Health care utilization and cost outcomes of a comprehensive dementia care program for medicare beneficiaries. JAMA Internal Medicine, 179(2), 161-166. https://doi.org/10.1001/jamainternmed.2018.5579.

25.

Kim

Helmer

D. A.

Zhao

Booockvar

(2011). Potentially preventable hospitalizations among older adults with diabetes. The American Journal of Managed Care, 17(11), 419-426.

26.

Langa

K. M.

Larson

E. B.

Crimmins

E. M.

Faul

J. D.

Levine

D. A.

Kabeto

M. U.

Weir

D. R.

(2017). A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51-58. https://doi.org/10.1001/jamainternmed.2016.6807.

27.

Lin

P.-J.

Fillit

H. M.

Cohen

J. T.

Neumann

P. J.

(2013). Potentially avoidable hospitalizations among medicare beneficiaries with Alzheimer’s disease and related disorders. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 9(1), 30-38. https://doi.org/10.1016/j.jalz.2012.11.002.

28.

Lin

P. J.

Zhong

Fillit

H. M.

Cohen

J. T.

Neumann

P. J.

(2017). Hospitalizations for ambulatory care sensitive conditions and unplanned readmissions among medicare beneficiaries with Alzheimer’s disease. Alzheimer’s and Dementia, 13(10), 1174-1178. https://doi.org/10.1016/j.jalz.2017.08.010.

29.

Moher

Liberati

Tetzlaff

Altman

D. G.

(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151(4), 264-269.

30.

National Center for Health Statistics (2020). Chapter 7: Dementias, including Alzheimer’s disease. Healthy people 2020 midcourse Review. Hyattsville, MD: Dementias Including Alzheimer’s Disease (DIA). www.healthypeople.gov/2020/topics-objectives/topic/.

31.

Nelis

S. M.

Y. T.

Matthews

F. E.

Martyr

Quinn

Rippon

Clare

(2019). The impact of co-morbidity on the quality of life of people with dementia: Findings from the IDEAL study. Age and Ageing, 48(3), 361-367. https://doi.org/10.1093/ageing/afy155.

32.

Noel

M. A.

Kaluzynski

T. S.

Templeton

V. H.

(2017). Quality dementia care: Integrating caregivers into a chronic disease management model. Journal of Applied Gerontology, 36(2), 195-212. https://doi.org/10.1177/0733464815589986.

33.

Peterson

Welch

Losos

Tugwell

P. J. O. O. H. R. I.

(2011). The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses (pp. 1-12). Ottawa: Ottawa Hospital Research Institute.

34.

Phelan

E. A.

Borson

Grothaus

Balch

Larson

E. B.

(2012). Association between incident dementia and risk of hospitalization. JAMA: The Journal of the American Medical Association, 307(2), 165-172. https://doi.org/10.1001/jama.2011.1964.Association.

35.

Phelan

E. A.

Debnam

K. J.

Anderson

L. A.

Owens

S. B.

(2015). A systematic review of intervention studies to prevent hospitalizations of community-dwelling older adults with dementia. Medical Care, 53(2), 207-213. https://doi.org/10.1097/MLR.0000000000000294.

36.

Possin

K. L.

Merrilees

J. J.

Dulaney

Bonasera

S. J.

Chiong

Lee

Miller

B. L.

(2019). Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the care Ecosystem randomized clinical trial. JAMA Internal Medicine, 179(12), 1658-1667. https://doi.org/10.1001/jamainternmed.2019.4101.

37.

Reuben

D. B.

Evertson

L. C.

Wenger

N. S.

Serrano

Chodosh

Ercoli

Tan

Z. S.

(2013). The university of California at Los Angeles alzheimer’s and dementia care program for comprehensive, coordinated, patient-centered care: preliminary data. Journal of the American Geriatrics Society, 61(12), 2214-2218. https://doi.org/10.1111/jgs.12562.

38.

Rudolph

J. L.

Zanin

N. M.

Jones

R. N.

Marcantonio

E. R.

Fong

T. G.

Yang

F. M.

Inouye

S. K.

(2010). Hospitalization in community-dwelling persons with Alzheimer’s disease: Frequency and causes. Journal of the American Geriatrics Society, 58(8), 1542-1548. https://doi.org/10.1111/j.1532-5415.2010.02924.x.

39.

Sadak

Foster Zdon

Ishado

Zaslavsky

Borson

(2017). Potentially preventable hospitalizations in dementia: Family caregiver experiences. International Psychogeriatrics, 29(7), 1201-1211. https://doi.org/10.1017/S1041610217000217.

40.

Samus

Q. M.

Johnston

Black

B. S.

Hess

Lyman

Vavilikolanu

Lyketsos

C. G.

(2014). A multidimensional home-based care coordination intervention for elders with memory disorders: The maximizing independence at home (MIND) pilot randomized trial. American Journal of Geriatric Psychiatry, 22(4), 398-414. https://doi.org/10.1016/j.jagp.2013.12.175.

41.

U.S. Department of Health and Human Services (2017). National and regional projections of supply and demand for geriatricians: 2013-2025. https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/GeriatricsReport51817.pdf.

42.

U.S. Department of Health and Human Services (2020). National plan to address alzheimer’s disease: 2020 update, 1–70. http://aspe.hhs.gov/daltcp/napa/NatlPlan.pdf.

43.

White

Fishman

Basu

Crane

P. K.

Larson

E. B.

Coe

N. B.

(2019). Medicare expenditures attributable to dementia. Health Services Research, 54(4), 773-781. https://doi.org/10.1111/1475-6773.13134.

44.

Zhu

C. W.

Cosentino

Ornstein

Scarmeas

Andrews

Stern

(2015). Medicare utilization and expenditures around incident dementia in a multiethnic cohort. Journals of Gerontology - Series A Biological Sciences and Medical Sciences, 70(11), 1448-1453. https://doi.org/10.1093/gerona/glv124.