A-01 Dementia Care Ecosystem: Health Care Utilization at Six Months

Abstract

Abstract Objective This study implemented the University of California, San Francisco (UCSF) Care Ecosystem Program, a Persons with Dementia (PWD)- and Caregiver (CG)-centered model of dementia care designed to improve quality of life and reduce the cost of care associated with emergency department (ED) visits and hospitalizations. Method Community-dwelling PWD and CGs at a southern regional medical system who had a diagnosis of dementia and at least one hospitalization or ED visit in the previous 12 months were prospectively enrolled in a mixed method study. These dyads (N = 54) completed monthly visits for six months, including behavior management, financial and advanced care planning, caregiver well-being, and navigating community and healthcare resources. PWD were predominantly Caucasian (70.4%; 30% African American) and female (53.7%), with an average age of 80.26 (SD = 6.99). CGs were demographically similar, but younger [M(SD) = 66.18(12.89)]. Results ED utilization decreased by 41% (51 visits in 6 months prior to enrollment vs. 30 visits post enrollment); [pre-M(SD) = 0.94(1.57); post-M(SD) = 0.56(1.11); 95% Confidence Interval − 0.09—0.86; t = 1.64, p > .05; Cohen’s d = 0.28]. On a paired samples t-test, there was a small effect despite not reaching statistical significance. Hospitalizations decreased by 43% (30 in 6 months prior to enrollment, 17 post enrollment); [pre-M(SD) = 0.56(1.09); post-M(SD) = 0.31(0.77); 95% Confidence Interval − 0.03—0.51; t = 1.79, p > .05; Cohen’s d = .26]. Again, there was a small effect despite not reaching statistical significance. Conclusions Preliminary results suggested a trend toward reduced hospital utilization. Future analysis on cost savings and other benefits of this type of program will be crucial to sustainability.