IMPROVING DEMENTIA CARE THROUGH DIGITAL CAREGIVER EMPOWERMENT: DURABLE CLAIMS‐BASED OUTCOMES DEMONSTRATED IN A PRAGMATIC REAL‐WORLD TRIAL

Topic: Risk, prevention and care in population studies

Abstract Objective The Ceresti Digital Caregiver Empowerment Program (DCEP) was deployed to 164 family caregivers of Medicare Advantage patients with ADOD. The primary objective of this pragmatic trial was to demonstrate that increasing the knowledge, skills and confidence of family caregivers (e.g., spouses, adult children) via personalized education, proactive coaching and remote monitoring—delivered via an app on a dedicated tablet computer—reduces avoidable patient hospitalizations. Durability of claims‐based outcomes was also studied. Caregiver engagement, caregiver satisfaction and caregiver mental health were also tracked Methods Patients were included in the claims analysis if their caregiver was enrolled in the DCEP for at least 45 days. Patient outcomes were compared to outcomes from a 3:1 propensity matched comparison group, post‐index, from the DCEP start date to the end of claims. Comparison group members were matched to enrollees on demographics, pre‐index utilization and costs, and other factors, including the patient’s frailty index. The first 30‐days post‐index were deemed a “transition” period. The impact of the DCEP was determined by comparing the 6‐month pre‐index averages to outcomes from the 30‐day post‐index period using the “difference‐in‐differences” approach (Figure 1). The index date for program enrollees was their DCEP start date. For matched comparison group patients, the index date was the program start date of the enrollee to whom the comparison group member is matched. The DCEP was personalized for each caregiver/patient dyad using predictive models applied to claims data. Results ‐ Patient Outcomes Table 1 summarizes statistically significant (p‐values 45 days, and enrolled high utilizers enrolled > 45 days (PMPM = per member/patient per month). High utilizers are patients with at least one hospitalization or two ED visits in the prior 24 months. Results were durable through 9 months post‐index (Figure 3). Conclusions Empowering family caregivers of patients with ADOD in a personalized DCEP provides durable reductions in patient hospitalizations and medical costs.

Key findings

• Patient outcomes were compared to outcomes from a 3:1 propensity matched comparison group, post‐index, from the DCEP start date to the end of claims.
• Results ‐ Patient Outcomes Table 1 summarizes statistically significant (p‐values 45 days, and enrolled high utilizers enrolled > 45 days (PMPM = per member/patient per month).
• Results were durable through 9 months post‐index (Figure 3).

Why it matters

This pragmatic trial of a digital caregiver empowerment program for family caregivers of Medicare Advantage patients with Alzheimer's disease and related dementias reported reductions in avoidable patient hospitalizations that were durable through 9 months. It suggests that supporting caregivers through education, coaching, and remote monitoring may help reduce hospital use, though it does not test a treatment or cure for the disease itself.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.1002/alz.066038
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@article{soenksen2022-ed962362,
  author  = {Soenksen, Dirk G. and Kleinman, Nathan L.},
  title   = {{IMPROVING DEMENTIA CARE THROUGH DIGITAL CAREGIVER EMPOWERMENT: DURABLE CLAIMS‐BASED OUTCOMES DEMONSTRATED IN A PRAGMATIC REAL‐WORLD TRIAL}},
  journal = {Alzheimer s \& Dementia},
  year    = {2022},
  doi     = {10.1002/alz.066038},
  url     = {https://doi.org/10.1002/alz.066038}
}

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