Document Type : Original Article
Radboud university medical center, Scientific center for quality of healthcare (IQ healthcare), Nijmegen, The Netherlands
Radboud university medical center, Department of Geriatric Medicine, Nijmegen, The Netherlands
Coöperatie Volksgezondheidszorg, Business intelligence services, Arnhem, The Netherlands
Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Geriatric Medicine, Radboud Alzheimer Centre, Nijmegen, The Netherlands
People with dementia are increasingly living at home, relying on primary care providers for most healthcare needs. Suboptimal collaboration and communication between providers could cause inefficiencies and worse patient outcomes. Innovative strategies are needed to address this growing disease burden and rising healthcare costs. The DementiaNet programme, a community care network approach targeted at patients with dementia in the Netherlands, has been shown to improve patient’s quality of care. However, very little is known about the impact of DementiaNet on admission risks and healthcare costs. This study addresses this knowledge gap.
A longitudinal cohort analysis was performed, using medical and long-term care claims data from 38 525 patients between 2015-2019. The primary outcomes were risk of hospital admission and annual total healthcare costs. Mixed-model regression analyses were used to identify changes in outcomes.
Patients who received care from a DementiaNet community care network showed a general trend in lower risk of admission for all types of admissions studied (ie, hospital, emergency ward, intensive care, crisis, and nursing home). Also, the intervention group showed a significant reduction of 12% in nursing days (relative risk [RR] 0.88; 95% CI: 0.77–0.96). No significant differences were found for total healthcare costs. However, we found effects in two sub-elements of total healthcare costs, being a decrease of 19.7% (95% CI: 7.7%–30.2%) in annual hospital costs and an increase of 10.2% (95% CI: 2.3%–18.6%) in annual primary care costs.
Our study indicates that DementiaNet’s community care network approach may reduce admission risks for patients with dementia over a long-term period of five years. This is accompanied by a decrease in nursing days and savings in hospital care that exceed increased primary care costs. This improvement in integrated dementia care supports wider scale implementation and evaluation of these networks.