COMPAS-E : Case management of dementia costs & effects of 4 implemented models

1. COMPAS-E : Case management of dementia costs & effects of 4 implemented models Hein van Hout1, Pim van den Dungen1, Janet MacNeil-Vroomen2, Lisa van Mierlo3, Franka Meiland3, Eric Moll van Charante4 , Sophia de Rooij21 VUmc, EMGO+, Dept . General Practice; 2 AMC, Dept . Geriatrics; 3 VUmc, EMGO+, Dept . Psychiatry & Nursing Home Medicine, Amsterdam; 4 AMC, Dept General Practice hpj.vanhout@vumc.nl Regions… Region I Home care model Region II Collaboration model Region III Primary care model Region IV Mental healh model Design CM=case management Usual care N=200 No CM N=100 No CM N=100 CM+ N=100 CM+ N=100 CM + N=100 CM + N=100 BACKGROUND Dementia care is undergoing a transition towards improved integrated (collaborative) care in the Netherlands. Case management plays a key role but varies from primary care to referral based specialised dementia care. OBJECTIVES: 1) To evaluate effects and costs of 4 models of case management compared to usual care, 2) To describe care trajectories of persons who do and do not receive CM. 3) To assess barriers and facilitators of implementation of CM. Primary outcomes: (1) Behavioural problems patient (NPI); (2) Mental Health caregiver (GHQ); Secondary outcomes: (3) Patient Quality of life (QoL-AD); (4) Met and unmet care needs (CANE); (5) Quality of care from caregiver perspective (6) Care Competence (SSCQ) Economic outcomes: (Cost of) care consumption MIXED METHODS Case control design across regions with and without case management over 24 months among 5x100-200 pairs of persons with dementia and their primary informal caregivers, matched on MMSE strata and living with a caregiver, in whom the effects of case management are compared to (non-case managed) usual care. 2) Cohorts within case management regions of 2x100 pairs of patients with dementia and their central informal caregiver. 3) Process analysis to identify facilitating and impeding factors in case management through the use of semi-structured interviews with key persons at the micro, meso and macro levels. DISCUSSION Post hoc stratification on MMSE level and living with or without a caregiver should increase comparability across regions with case management. Post hoc adjustment of other imbalance should provide additional control. Limitations: Comparability of the groups might fail on other characteristics: e.g. GPs motives and patient wishes for referral. GRANT Netherlands organization for health research and development (ZonMw–NPO nr 313080201)