Collaborative care management reduces disparities in dementia care quality for caregivers with less education

摘要

Objectives To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver. Design Analysis of data from a cluster-randomized controlled trial. Setting Eighteen clinics in three healthcare organizations in southern California. Participants Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver. Intervention Collaborative care management for dementia. Measurements Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants. Results At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P <.001 for all three). Conclusions Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education. ? 2013,