PDF(Pubmed)
Abstract：
BACKGROUND: People with dementia are increasingly living at home, relying on primary care providers for most healthcare needs. Suboptimal collaboration and communication between providers could cause inefficiencies and worse patient outcomes. Innovative strategies are needed to address this growing disease burden and rising healthcare costs. The DementiaNet programme, a community care network approach targeted at patients with dementia in the Netherlands, has been shown to improve patient\'s quality of care. However, very little is known about the impact of DementiaNet on admission risks and healthcare costs. This study addresses this knowledge gap.
METHODS: A longitudinal cohort analysis was performed, using medical and long-term care claims data from 38 525 patients between 2015-2019. The primary outcomes were risk of hospital admission and annual total healthcare costs. Mixed-model regression analyses were used to identify changes in outcomes.
RESULTS: Patients who received care from a DementiaNet community care network showed a general trend in lower risk of admission for all types of admissions studied (ie, hospital, emergency ward, intensive care, crisis, and nursing home). Also, the intervention group showed a significant reduction of 12% in nursing days (relative risk [RR] 0.88; 95% CI: 0.77- 0.96). No significant differences were found for total healthcare costs. However, we found effects in two sub-elements of total healthcare costs, being a decrease of 19.7% (95% CI: 7.7%-30.2%) in annual hospital costs and an increase of 10.2% (95% CI: 2.3%-18.6%) in annual primary care costs.
CONCLUSIONS: Our study indicates that DementiaNet\'s community care network approach may reduce admission risks for patients with dementia over a long-term period of five years. This is accompanied by a decrease in nursing days and savings in hospital care that exceed increased primary care costs. This improvement in integrated dementia care supports wider scale implementation and evaluation of these networks.
METHODS: A longitudinal cohort analysis was performed, using medical and long-term care claims data from 38 525 patients between 2015-2019. The primary outcomes were risk of hospital admission and annual total healthcare costs. Mixed-model regression analyses were used to identify changes in outcomes.
RESULTS: Patients who received care from a DementiaNet community care network showed a general trend in lower risk of admission for all types of admissions studied (ie, hospital, emergency ward, intensive care, crisis, and nursing home). Also, the intervention group showed a significant reduction of 12% in nursing days (relative risk [RR] 0.88; 95% CI: 0.77- 0.96). No significant differences were found for total healthcare costs. However, we found effects in two sub-elements of total healthcare costs, being a decrease of 19.7% (95% CI: 7.7%-30.2%) in annual hospital costs and an increase of 10.2% (95% CI: 2.3%-18.6%) in annual primary care costs.
CONCLUSIONS: Our study indicates that DementiaNet\'s community care network approach may reduce admission risks for patients with dementia over a long-term period of five years. This is accompanied by a decrease in nursing days and savings in hospital care that exceed increased primary care costs. This improvement in integrated dementia care supports wider scale implementation and evaluation of these networks.
摘要：
背景：痴呆症患者越来越多地居住在家中，依靠初级保健提供者来满足大多数医疗保健需求。提供者之间的合作和沟通欠佳可能会导致效率低下和患者预后恶化。需要创新的策略来解决这种不断增长的疾病负担和不断上升的医疗保健成本。DementiaNet计划,荷兰针对痴呆症患者的社区护理网络方法，已被证明可以提高患者的护理质量。然而,关于DementiaNet对入院风险和医疗保健成本的影响知之甚少。这项研究解决了这种知识差距。
方法：进行了纵向队列分析，使用2015-2019年间38525例患者的医疗和长期护理索赔数据.主要结果是住院风险和年度总医疗费用。使用混合模型回归分析来确定结果的变化。
结果：从DementiaNet社区护理网络接受护理的患者在所研究的所有类型的入院中显示出入院风险较低的总体趋势（即，医院,急诊病房,重症监护,危机,和疗养院）。此外，干预组护理天数显著减少12%(相对危险度[RR]0.88;95%CI:0.77~0.96).医疗总费用没有显著差异。然而,我们发现了医疗总费用的两个子要素的影响，年度住院费用下降19.7%（95%CI：7.7%-30.2%），年度初级保健费用上升10.2%（95%CI：2.3%-18.6%）。
结论：我们的研究表明，DementiaNet的社区护理网络方法可以在五年的长期内降低痴呆患者的入院风险。伴随着护理天数的减少和医院护理的节省，超过了增加的初级保健费用。综合痴呆症护理的这种改进支持了这些网络的更大规模的实施和评估。
方法：进行了纵向队列分析，使用2015-2019年间38525例患者的医疗和长期护理索赔数据.主要结果是住院风险和年度总医疗费用。使用混合模型回归分析来确定结果的变化。
结果：从DementiaNet社区护理网络接受护理的患者在所研究的所有类型的入院中显示出入院风险较低的总体趋势（即，医院,急诊病房,重症监护,危机,和疗养院）。此外，干预组护理天数显著减少12%(相对危险度[RR]0.88;95%CI:0.77~0.96).医疗总费用没有显著差异。然而,我们发现了医疗总费用的两个子要素的影响，年度住院费用下降19.7%（95%CI：7.7%-30.2%），年度初级保健费用上升10.2%（95%CI：2.3%-18.6%）。
结论：我们的研究表明，DementiaNet的社区护理网络方法可以在五年的长期内降低痴呆患者的入院风险。伴随着护理天数的减少和医院护理的节省，超过了增加的初级保健费用。综合痴呆症护理的这种改进支持了这些网络的更大规模的实施和评估。
