Project Summary

PCORI has identified the need for large studies that look at real-life questions facing diverse patients, caregivers, and clinicians. In 2014, PCORI launched the Pragmatic Clinical Studies initiative to support large-scale comparative effectiveness studies focusing on everyday care for a wide range of patients. The Pragmatic Clinical Studies initiative funded this research project.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Dementia is a health problem that can cause memory loss, behavior and mood changes, inability to perform daily tasks, falls, and swallowing problems. Alzheimer’s disease is the most common form of dementia, affecting about 5.7 million people in the United States. Symptoms of dementia can lead caregivers to have stress, depression, and illness.

This study compares three ways to reduce behavior problems in patients with dementia and to lower stress among family members or friends who care for them. In the first way, a nurse practitioner or physician assistant manages dementia care with the patient’s primary care doctor. In the second way, a nurse or social worker based at a community center manages care over the telephone. The third way is usual care plus referral to the Alzheimer’s Association hotline.

Who can this research help?

Results can help doctors, patients, and caregivers when considering ways to manage dementia.

What is the research team doing?

The research team is recruiting 2,150 patient-caregiver pairs from primary care clinics. All patients in the study have dementia. All live at home or in an assisted living facility. The team is assigning each patient-caregiver pair to one of three groups by chance. Patients in all three groups take part in their assigned program for 18 months.

In the first group, 1,000 patients are receiving dementia care from a nurse practitioner or physician assistant within a primary care clinic. A doctor oversees and adjusts care based on patient and caregiver needs.

In the second group, 1,000 patients are receiving dementia care from a nurse or social worker based at a community center. The program gives equal attention to patients and caregivers. Caregivers can take part in the program even if patients can’t because of their dementia. Program content, resources, and referrals are tailored to patient and caregiver needs.

In the third group, 150 patients receive standard dementia care plus educational materials and referral to the Alzheimer’s Association hotline. This hotline provides decision-making support, crisis help, caregiver education, and referral to local services.

Caregivers complete a survey at the time they enter the study. They complete the survey again 3, 6, 12, and 18 months later. Across the three groups, the research team is comparing caregivers’

  • Perceptions of the patient’s behavioral symptoms
  • Level of strain
  • Distress related to the patient’s dementia
  • Severity of depression
  • Confidence in their ability to manage the patient’s dementia

Patients with early stage dementia, caregivers, health system leaders, insurers, and advocacy groups are helping plan and conduct the study.

Research methods at a glance

Design Elements Description
Design Randomized controlled trial
Population 2,150 patients with dementia who reside at home or in an assisted living facility and their unpaid caregiver (family member or friend)
Interventions/
Comparators
  • Health-system-based dementia care
  • Community-based dementia care
  • Enhanced usual care
Outcomes

Primary: caregiver perceptions of the severity of the patient’s dementia-related behavioral symptoms, caregiver strain

Secondary: caregiver distress due to dementia-related psychiatric and behavioral symptoms, severity of caregiver depression, caregiver self-efficacy

Timeframe Timeframe Length of follow-up for collecting data on primary outcomes. View Glossary 18-month follow-up for primary outcomes

Project Information

David Reuben, MD
Regents of the University of California, Los Angeles
$16,577,820
Comparative Effectiveness of Health System-based versus Community-based Dementia Care -- D-CARE -- The Dementia Care Study

Key Dates

November 2017
September 2024
2017

Study Registration Information

Tags

Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 26, 2022