Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs.
Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs.
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DOI：
10.1111/jgs.14716
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发表时间：
2017-05
影响因子：
6.3
通讯作者：
Waters TM
中科院分区：
文献类型：
--
作者：
Nichols LO;Martindale-Adams J;Zhu CW;Kaplan EK;Zuber JK;Waters TM
检查照顾者和照顾者医疗成本与照顾者参与增强阿尔茨海默氏症照顾者健康(REACH II或REACH VA)行为干预以改善应对技能和照顾者管理相关的成本。随机对照试验(REACH II)；倾向-得分匹配，回顾性队列研究(REACH VA)。5个社区站点(REACH II)；24个VA设施(REACH VA)。患有阿尔茨海默病和相关痴呆症的护理接受者(ADRD)及其参加REACH II研究的照顾者(分析样本为110名照顾者和197名照顾者)、照顾者参与REACH VA的照顾者和倾向匹配的对照组(分析样本为491人)。以前收集的数据加上医疗保险支出(REACH II)和VA成本加上医疗保险支出(REACH VA)，参加REACH干预的护理接受者或他们的照顾者的VA或医疗保险支出没有增加。对于退伍军人护理接受者，REACH与显著较低的退伍军人护理总成本(33.6%)相关。无法获得退伍军人管理局护理员费用数据。在之前的研究中，REACH II和REACH VA都被证明以每天不到5美元的成本为痴呆症照顾者提供好处；然而，对额外医疗成本的担忧可能阻碍了REACH的广泛采用。REACH干预与照顾者或患者的额外医疗成本都不相关；事实上，对于VA患者，医疗成本显著较低。退伍军人管理局节省的费用可能与增加了结构化格式有关，以解决护理人员在管理现有综合护理系统中复杂的ADRD护理方面的角色。这些发现表明，行为干预是一种可行的机制，可以在不增加医疗费用的情况下支持负担沉重的痴呆症照顾者。
Examine caregiver and care recipient healthcare costs associated with caregivers’ participation in Resources for Enhancing Alzheimer’s Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management. RCT (REACH II); propensity-score matched, retrospective cohort study (REACH VA). Five community sites (REACH II); 24 VA facilities (REACH VA). Care recipients with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers who participated in REACH II study (analysis sample of 110 caregivers and 197 care recipients); care recipients whose caregivers participated in REACH VA and a propensity matched control group (analysis sample of 491). Previously collected data plus Medicare expenditures (REACH II) and VA costs plus Medicare expenditures (REACH VA) There was no increase in VA or Medicare expenditures for care recipients or their caregivers who participated in either REACH intervention. For VA care recipients, REACH was associated with significantly lower total VA costs of care (33.6%). VA caregiver cost data was not available. In previous research, both REACH II and REACH VA have been shown to provide benefit for dementia caregivers at a cost of less than $5/day; however, concerns about additional healthcare costs may have hindered REACH’s widespread adoption. Neither REACH intervention was associated with additional healthcare costs for caregivers or patients; in fact, for VA patients, there were significantly lower healthcare costs. The VA costs savings may be related to the addition of a structured format for addressing the caregiver’s role in managing complex ADRD care to an existing, integrated care system. These findings suggest that behavioral interventions are a viable mechanism to support burdened dementia caregivers without additional healthcare costs.