Comparing Dutch Case management care models for people with dementia and their caregivers: The design of the COMPAS study.

Background:

Dementia care in the Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalised care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in the Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered.



Design:

Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of the Netherlands with and without case management including a qualitative process evaluation. Inclusion criteria for the cohort study are: community-dwelling individuals with a dementia diagnosis who are not terminally-ill or anticipate admission to a nursing home within 6 months and with an informal caregiver who speaks fluent Dutch. Person with dementia-informal caregiver dyads are followed for two years. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Secondary outcomes include: quality of life and needs assessment in both persons with dementia and caregivers, activity of daily living, competence of care, and number of crises. Costs are measured from a societal perspective using cost diaries. Process indicators measure the quality of care from the participant’s perspective.

The qualitative study uses purposive sampling methods to ensure a wide variation of respondents. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned.



Discussion:

This study provides relevant insights into care processes, description of two case management models along with clinical and economic data from persons with dementia and caregivers to clarify important differences in two case management care models compared to usual care.

Our first hypothesis is that in the two exisiting case management models, the persons with dementia will have less behaviour and mood problems than persons receiving usual care and informal caregivers experience better mental health compared to usual care. Furthermore, we expect a delay in nursing home admission for persons with dementia versus usual care because care needs are better monitored and followed up by services that cooperate within a chain of care. Additionally, an exploratory hypothesis is whether the intensive care/joint agency model is associated with fewer behavioural problems and better follow up care compared to the linkage model, as the services that are part of one organisation may generate more efficiency.

Baseline, six, twelve, eighteen and 24 months.

Two different case management models compared to usual care. These models are already implemented in Dutch community care.