Home › Research › Health systems and care delivery
Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial
Guterman Elan L, Kiekhofer Rachel E, Wood Andrew J, Allen I Elaine, Kahn James G, Dulaney Sarah, Merrilees Jennifer J, Lee Kirby et al.. JAMA internal medicine, 2023-09-18
Topic: Risk, prevention and care in population studies
Collaborative dementia care programs are effective in addressing the needs of patients with dementia and their caregivers. However, attempts to consider effects on health care spending have been limited, leaving a critical gap in the conversation around value-based dementia care. To determine the effect of participation in collaborative dementia care on total Medicare reimbursement costs compared with usual care. This was a prespecified secondary analysis of the Care Ecosystem trial, a 12-month, single-blind, parallel-group randomized clinical trial conducted from March 2015 to March 2018 at 2 academic medical centers in California and Nebraska. Participants were patients with dementia who were living in the community, aged 45 years or older, and had a primary caregiver and Medicare fee-for-service coverage for the duration of the trial. Telehealth dementia care program that entailed assignment to an unlicensed dementia care guide who provided caregiver support, standardized education, and connection to licensed dementia care specialists. Primary outcome was the sum of all Medicare claim payments during study enrollment, excluding Part D (drugs). Of the 780 patients in the Care Ecosystem trial, 460 (59.0%) were eligible for and included in this analysis. Patients had a median (IQR) age of 78 (72-84) years, and 256 (55.7%) identified as female. Participation in collaborative dementia care reduced the total cost of care by $3290 from 1 to 6 months postenrollment (95% CI, -$6149 to -$431; P = .02) and by $3027 from 7 to 12 months postenrollment (95% CI, -$5899 to -$154; P = .04), corresponding overall to a mean monthly cost reduction of $526 across 12 months. An evaluation of baseline predictors of greater cost reduction identified trends for recent emergency department visit (-$5944; 95% CI, -$10 336 to -$1553; interaction P = .07) and caregiver depression (-$6556; 95% CI, -$11 059 to -$2052; interaction P = .05). In this secondary analysis of a randomized clinical trial among Medicare beneficiaries with dementia, the Care Ecosystem model was associated with lower total cost of care compared with usual care. Collaborative dementia care programs are a cost-effective, high-value model for dementia care. ClinicalTrials.gov Identifier: NCT02213458.
Key findings
- To determine the effect of participation in collaborative dementia care on total Medicare reimbursement costs compared with usual care.
- Participation in collaborative dementia care reduced the total cost of care by $3290 from 1 to 6 months postenrollment (95% CI, -$6149 to -$431; P = .02) and by $3027 from 7 to 12 months postenrollment (95% CI, -$5899 to -$154; P = .04), corresponding overall to a mean monthly cost reduction of $526 across 12 months.
- In this secondary analysis of a randomized clinical trial among Medicare beneficiaries with dementia, the Care Ecosystem model was associated with lower total cost of care compared with usual care.
Why it matters
In a planned secondary analysis of a randomized trial of 460 Medicare fee-for-service patients with dementia, a telehealth programme was linked to lower total Medicare costs than usual care: a mean of about $526 a month over 12 months, excluding drug costs. In the programme, an unlicensed care guide supported the caregiver and connected the family to dementia specialists. The study measured spending only, not patient or caregiver well-being, and says nothing about treating or preventing Alzheimer's.
Study details
- Participants780
- Effect size59.0%; 55.7%
- Evidence strengthHigh
How this study scored 65/100
Published in a leading specialty journal. Scored zero for study design because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here and still being cited, so those were left out: it earned 47 of the 72 points we could judge it on, which is 65 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA internal medicine) |
| Journal's citation record | 3 / 4 | JAMA Internal Medicine: journal h-index 258 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 2 / 4 | 780 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | — / 7 | Citation count not trusted: 6 of 14 library studies citing it were published more than a year before it - a sign OpenAlex merged several works under this DOI — left out of this score |
| Citations per year | — / 5 | Citation count not trusted (see above) — left out of this score |
| Impact for its field and year | — / 6 | Citation count not trusted (see above) — left out of this score |
| Cited by studies here | — / 6 | Library citations not trusted (see above) — left out of this score |
| Still being cited | — / 4 | Citation count not trusted (see above) — left out of this score |
| Senior author's track record | 3 / 4 | Last-listed author Katherine L. Possin: h-index 57 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,912 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 37721734) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 47 / 72 | Scored on 15 of 20 parts. We have no data for the rest, so they are left out: 47 of the 72 points we could judge it on is 65 out of 100. |
| Total | 65 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Guterman Elan, L., Kiekhofer Rachel, E., Wood Andrew, J., Elaine, A. I., Kahn James, G., Sarah, D., et al. (2023). Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial. JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2023.4764
Vancouver
Guterman Elan L, Kiekhofer Rachel E, Wood Andrew J, Elaine AI, Kahn James G, Sarah D, et al. Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial. JAMA internal medicine. 2023. doi:10.1001/jamainternmed.2023.4764. PMID: 37721734.
BibTeX
@article{gutermanelan2023-37721734,
author = {Guterman Elan, L. and Kiekhofer Rachel, E. and Wood Andrew, J. and Elaine, Allen I and Kahn James, G. and Sarah, Dulaney and Merrilees Jennifer, J. and Kirby, Lee and others},
title = {{Care Ecosystem Collaborative Model and Health Care Costs in Medicare Beneficiaries With Dementia: A Secondary Analysis of a Randomized Clinical Trial}},
journal = {JAMA internal medicine},
year = {2023},
doi = {10.1001/jamainternmed.2023.4764},
pmid = {37721734},
url = {https://doi.org/10.1001/jamainternmed.2023.4764}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here.
Later studies that cite this one
14 studies in the alzhub library list this one in their references. Showing the 8 highest-scoring.
Related studies in Health systems and care delivery
Also tagged “care”
996 studies in the library carry the topic tag “care”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 996 tagged studies.