University of California, San Francisco/Global Brain Health Institute, San Francisco, California.
Philip R. Less Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California.
J Am Geriatr Soc. 2019 Dec;67(12):2628-2633. doi: 10.1111/jgs.16076. Epub 2019 Jul 18.
Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. We evaluate the direct costs of implementing a collaborative dementia care program.
We applied a micro-costing analysis to calculate operational costs per-participant-month between March 2015 and May 2017.
The University of California, San Francisco (UCSF) and the University of Nebraska Medical Center (UNMC).
Participants diagnosed with dementia, enrolled in Medicare or Medicaid, 45 years of age or older, residents of California, Nebraska or Iowa, and having a caregiver. The sample was 272 (UCSF) and 192 (UNMC) participants.
A collaborative dementia care program provided by care team navigators (CTNs), advanced practice nurses, a social worker, and a pharmacist, focusing on caregiver support and education, medications, advance care planning, and behavior symptom management.
We measured costs (personnel, supplies, equipment, and training costs) during three program periods, Start-up, Early Operations, and Continuing Operations, and estimated the effects of caseload variation on costs.
Start-up and Early Operations costs were, respectively, $581 and $328 (California), and $501 and $219 (Nebraska) per-participant-month. Average costs decreased across phases to $241 (California) and $142 (Nebraska) per-participant-month during Continuing Operations. We estimated that costs would range between $75 (UNMC) and $92 (UCSF) per-participant-month with the highest projected caseloads (90).
We found that CTN caseload is an important driver of service cost. We provide strategies for maximizing caseload without sacrificing quality of care. We also discuss current barriers to broad implementation that can inform new reimbursement policies. J Am Geriatr Soc 67:2628-2633, 2019.
协调护理计划可以改善患者的预后并降低医疗支出；然而，实施成本却知之甚少。我们评估实施协作性痴呆护理计划的直接成本。
我们采用微观成本分析来计算 2015 年 3 月至 2017 年 5 月期间每个参与者/月的运营成本。
加利福尼亚大学旧金山分校（UCSF）和内布拉斯加大学医学中心（UNMC）。
被诊断患有痴呆症、参加医疗保险或医疗补助、年龄在 45 岁或以上、居住在加利福尼亚州、内布拉斯加州或爱荷华州且有照顾者的参与者。样本为 272 名（UCSF）和 192 名（UNMC）参与者。
由护理团队导航员（CTN）、高级执业护士、社会工作者和药剂师提供的协作性痴呆护理计划，重点是照顾者支持和教育、药物、预先护理计划和行为症状管理。
我们在启动、早期运营和持续运营三个阶段测量了成本（人员、用品、设备和培训成本），并估计了病例量变化对成本的影响。
启动和早期运营阶段的成本分别为加利福尼亚州每个参与者/月 581 美元和 328 美元，内布拉斯加州每个参与者/月 501 美元和 219 美元。在持续运营阶段，各阶段的平均成本下降至加利福尼亚州每个参与者/月 241 美元和内布拉斯加州每个参与者/月 142 美元。我们估计，在最高预测病例量（90）下，每个参与者/月的成本范围在 75 美元（UNMC）至 92 美元（UCSF）之间。
我们发现 CTN 病例量是服务成本的重要驱动因素。我们提供了在不牺牲护理质量的情况下最大限度地增加病例量的策略。我们还讨论了广泛实施的当前障碍，这可以为新的报销政策提供信息。美国老年学会杂志 67:2628-2633,2019。
