Clinical trial NCT02395731: Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
Official title: Comprehensive Home-based Dementia Care Coordination for Medicare-Medicaid Dual Eligibles in Maryland
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Dementia
Caregiver Burden
Keywords: dual eligible
care coordination
community-based
care quality
care needs
health services
care management
low income
Neuropsychiatric behaviors
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
Collaborators: name: Jewish Community Services
name: Johns Hopkins Home Care Group
name: Centers for Medicare and Medicaid Services
First posted: 2015-03-24
Enrollment: 342
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This Center for Medicare and Medicaid funded health care innovation award will implement the MIND at Home dementia care coordination program (called MIND at Home-Plus) through two community-based service agencies (Jewish Community Services, Johns Hopkins Home Care Group) to rapidly improve the ability of 600 dually eligible older adults with dementia in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs. MIND at Home participants receive an in-home needs assessment followed by up to 18 months of care coordination aimed at filling unmet needs.

Detailed description: The demonstration project has 3 major tasks which will be implemented in concurrent, iterative phases: (1) implement MIND-Plus in 2 community-based health service agencies to rapidly improve the ability of 600 community-living dually eligible older adults with AD in the Baltimore region to remain at home while improving care quality, enhancing quality of life, and reducing total health care costs associated with institutional care or hospitalization; (2) develop a replicable model for nationwide diffusion of the MIND program through a web-based certification package designed to prepare for implementation, build work-force capacity through training certification modules, and provide automated self-monitoring and quality improvement tools; and (3) develop and test a detailed payment model that takes a blended approach and includes provider care management fees with provider performance incentives from division of shared savings.

The investigators hypothesize that the MIND-Plus dementia care coordination program will (1) rapidly improve health \& care quality and reduce total health care costs among Medicare-Medicaid dually eligible community-living older adults with AD, (2) drive health care system transformation by creating a new CMS financed benefit that would shift the hub of dementia care coordination to well-trained, dementia competent, interdisciplinary teams based in community health agencies, (3) achieve a sustainable payment model that produces significant net savings and incentives provider performance. This "shovel ready" community-based model is expected to improve outcomes within 6 months and save an estimated net-saving of $12.5 million by over 3 years.

Eligibility criteria: Inclusion Criteria:

* diagnosis of dementia
* community living
* has identified study partner willing to participate
* english speaking

Exclusion Criteria:

* situation at time of referral is a medical or mental health crisis
* they plan to move out to another area or into a residential care facility in the next 6 months
* they are currently on hospice.

Primary outcomes:
measure: Net cost offset (Medicare and Medicaid costs) of intervention
timeFrame: 18 months
Secondary outcomes:
measure: Change in patient quality of life at 18 months
timeFrame: baseline to 18 months
measure: Change in caregiver quality of life at 18 months
timeFrame: baseline to 18 months
measure: Change in patient unmet dementia-related care needs
timeFrame: baseline to 18 months
measure: Change in caregiver unmet dementia-related care needs
timeFrame: baseline to 18 months
measure: Time to long term care placement or death
timeFrame: 18 months
measure: Time to long term care placement or death
timeFrame: 24 months
measure: Change in neuropsychiatric behavior symptoms at 18 months
timeFrame: baseline to 18 months
measure: Hospitalization rates
timeFrame: 18 months
measure: 30 day re-hospitalization rates
timeFrame: 18 months
measure: Emergency department rates
timeFrame: 18 months
measure: Change in patient depression at 18 months
timeFrame: baseline to 18 months
measure: Change in caregiver depression at 18 months
timeFrame: baseline to 18 months
measure: Change in caregiver subjective burden at 18 months
timeFrame: baseline to 18 months
measure: Change in caregiver objective burden at 18 months
timeFrame: baseline to 18 months
Other outcomes:
measure: Intervention acceptability
timeFrame: 18 months
measure: Provider satisfaction
timeFrame: 3 years
Locations:
city: Baltimore
country: United States
facility: Johns Hopkins University
state: Maryland
Study officials:
affiliation: Johns Hopkins University
name: Quincy Samus, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Samus QM, Davis K, Willink A, Black BS, Reuland M, Leoutsakos J, Roth DL, Wolff J, Gitlin LN, Lyketsos CG, Johnston D. Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus-Study protocol. Int J Care Coord. 2017 Dec;20(4):123-134. doi: 10.1177/2053434517744071. Epub 2017 Dec 14.