Effects of DementiaNet’s Community Care Network Approach on Admission Rates and Healthcare Costs: A Longitudinal Cohort Analysis

Document Type : Original Article


1 Radboud university medical center, Scientific center for quality of healthcare (IQ healthcare), Nijmegen, The Netherlands

2 Radboud university medical center, Department of Geriatric Medicine, Nijmegen, The Netherlands

3 Coöperatie Volksgezondheidszorg, Business intelligence services, Arnhem, The Netherlands

4 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.


  1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446. doi:1016/s0140-6736(20)30367-6
  2. Toot S, Devine M, Akporobaro A, Orrell M. Causes of hospital admission for people with dementia: a systematic review and meta-analysis. J Am Med Dir Assoc. 2013;14(7):463-470. doi:1016/j.jamda.2013.01.011
  3. Mondor L, Maxwell CJ, Hogan DB, et al. Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: a retrospective analysis of a population-based cohort. PLoS Med. 2017;14(3):e1002249. doi:1371/journal.pmed.1002249
  4. Bauer K, Schwarzkopf L, Graessel E, Holle R. A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 2014;14:10. doi:1186/1471-2318-14-10
  5. World Health Organization (WHO). Global Action Plan on the Public Health Response to Dementia 2017-2025. WHO; 2017.
  6. Stadhouders N, Kruse F, Tanke M, Koolman X, Jeurissen P. Effective healthcare cost-containment policies: a systematic review. Health Policy. 2019;123(1):71-79. doi:1016/j.healthpol.2018.10.015
  7. Reilly S, Miranda-Castillo C, Malouf R, et al. Case management approaches to home support for people with dementia. Cochrane Database Syst Rev. 2015;1(1):CD008345. doi:1002/14651858.CD008345.pub2
  8. Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2006;295(18):2148-2157. doi:1001/jama.295.18.2148
  9. Campbell J, Dussault G, Buchan J, et al. A Universal Truth: No Health Without a Workforce. Geneva: Global Health Workforce Alliance, World Health Organization; 2013.
  10. Meeuwsen E, Melis R, van der Aa G, et al. Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial. PLoS One. 2013;8(11):e79797. doi:1371/journal.pone.0079797
  11. Meeuwsen EJ, Melis RJ, Van Der Aa GC, et al. Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial. BMJ. 2012;344:e3086. doi:1136/bmj.e3086
  12. Graff MJ, Adang EM, Vernooij-Dassen MJ, et al. Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study. BMJ. 2008;336(7636):134-138. doi:1136/bmj.39408.481898.BE
  13. Nieuwboer MS, Richters A, van der Marck MA. Triple aim improvement for individuals, services and society in dementia care: the DementiaNet collaborative care approach. Z Gerontol Geriatr. 2017;50(Suppl 2):78-83. doi:1007/s00391-017-1196-4
  14. Richters A, Nieuwboer MS, Olde Rikkert MGM, Melis RJF, Perry M, van der Marck MA. Longitudinal multiple case study on effectiveness of network-based dementia care towards more integration, quality of care, and collaboration in primary care. PLoS One. 2018;13(6):e0198811. doi:1371/journal.pone.0198811
  15. Oostra DL, Harmsen A, Nieuwboer MS, Rikkert M, Perry M. Care integration in primary dementia care networks: a longitudinal mixed-methods study. Int J Integr Care. 2021;21(4):29. doi:5334/ijic.5675
  16. Oostra DL, Nieuwboer MS, Melis RJF, Remers TEP, Olde Rikkert MGM, Perry M. DementiaNet facilitates a sustainable transition toward integrated primary dementia care: a long-term evaluation. Alzheimers Dement. 2023. doi:1002/alz.13154
  17. Ypinga JHL, de Vries NM, Boonen L, et al. Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: a retrospective analysis of medical claims data. Lancet Neurol. 2018;17(2):153-161. doi:1016/s1474-4422(17)30406-4
  18. Ha NHL, Chan I, Yap P, et al. Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia. BMJ Open. 2020;10(10):e039017. doi:1136/bmjopen-2020-039017
  19. Thanh NX, Patil T, Knudsen C, et al. Return on investment of the primary health care integrated geriatric services initiative implementation. J Ment Health Policy Econ. 2020;23(3):101-109.
  20. Wübbeler M, Thyrian JR, Michalowsky B, et al. How do people with dementia utilise primary care physicians and specialists within dementia networks? Results of the Dementia Networks in Germany (DemNet-D) study. Health Soc Care Community. 2017;25(1):285-294. doi:1111/hsc.12315
  21. Nijhof E, Romp M, van Schip-Wagter E. Verzekerden in beeld 2021 - Inzicht in het overstapseizoen. Vektis; 2021.
  22. Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E. Netherlands: health system review. Health Syst Transit. 2016;18(2):1-240.
  23. van den Pol H, Luijk R, Leegwater E. Zorggebruik van mensen met dementie in beeld - zorggebruik indicatoren dementienetwerken. Vektis; 2019.
  24. Majumder MS, Rose S. Health Care Claims Data May Be Useful For COVID-19 Research Despite Significant Limitations. Health Aff Blog. October 6, 2020. doi:1377/forefront.20201001.977332
  25. Mot ES, Aouragh A, de Groot M, Mannaerts H. The Dutch System of Long-Term Care. Citeseer; 2010.
  26. Wammes JD, Bakx P, Wouterse B, Buurman BM, Murphy TE, MacNeil Vroomen JL. Acute hospital use in older adults following the 2015 Dutch reform of long-term care: an interrupted time series analysis. Lancet Healthy Longev. 2023;4(6):e257-e264. doi:1016/s2666-7568(23)00064-8
  27. Malehi AS, Pourmotahari F, Angali KA. Statistical models for the analysis of skewed healthcare cost data: a simulation study. Health Econ Rev. 2015;5:11. doi:1186/s13561-015-0045-7
  28. Garre-Olmo J, Ponjoan A, Inoriza JM, et al. Survival, effect measures, and impact numbers after dementia diagnosis: a matched cohort study. Clin Epidemiol. 2019;11:525-542. doi:2147/clep.s213228
  29. Schwarzkopf L, Menn P, Leidl R, et al. Excess costs of dementia disorders and the role of age and gender - an analysis of German health and long-term care insurance claims data. BMC Health Serv Res. 2012;12:165. doi:1186/1472-6963-12-165
  30. Hsiao FY, Peng LN, Wen YW, Liang CK, Wang PN, Chen LK. Care needs and clinical outcomes of older people with dementia: a population-based propensity score-matched cohort study. PLoS One. 2015;10(5):e0124973. doi:1371/journal.pone.0124973
  31. Douven R, Burger M, Schut E. Grote prijsverschillen ziekenhuiszorg, ondanks concurrentie. Econ Stat Ber. 2018;103(4762):276-279.
  32. Lee DA, Tirlea L, Haines TP. Non-pharmacological interventions to prevent hospital or nursing home admissions among community-dwelling older people with dementia: a systematic review and meta-analysis. Health Soc Care Community. 2020;28(5):1408-1429. doi:1111/hsc.12984
  33. Kim HS, Lee S, Kim JH. Real-world evidence versus randomized controlled trial: clinical research based on electronic medical records. J Korean Med Sci. 2018;33(34):e213. doi:3346/jkms.2018.33.e213
  34. European Observatory on Health Systems and Policies (OECD). Germany: Country Health Profile 2019. Paris: OECD Publishing; 2019. doi:1787/36e21650-en
  35. Eijsvogels TMH, Maessen MFH, Bakker EA, et al. Association of cardiac rehabilitation with all-cause mortality among patients with cardiovascular disease in the Netherlands. JAMA Netw Open. 2020;3(7):e2011686. doi:1001/jamanetworkopen.2020.11686
  36. Riley WT, Keberlein P, Sorenson G, et al. Program evaluation of remote heart failure monitoring: healthcare utilization analysis in a rural regional medical center. Telemed J E Health. 2015;21(3):157-162. doi:1089/tmj.2014.0093
  • Receive Date: 23 September 2022
  • Revise Date: 21 August 2023
  • Accept Date: 07 October 2023
  • First Publish Date: 08 October 2023