{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T18:47:01Z","timestamp":1793299621290,"version":"4.5.0"},"reference-count":73,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Long-term evidence for the effectiveness and cost-effectiveness of collaborative dementia care management (CDCM) is lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate whether 6 months of CDCM is associated with improved patient clinical outcomes and caregiver burden and is cost-effective compared with usual care over 36 months.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a prespecified secondary analysis of a general practitioner (GP)\u2013based, cluster randomized, 2-arm clinical trial conducted in Germany from January 1, 2012, to December 31, 2014, with follow-up until March 31, 2018. Participants were aged 70 years or older, lived at home, and screened positive for dementia. Data were analyzed from March 2011 to March 2018.<\/jats:p><\/jats:sec>Intervention<\/jats:title>The intervention group received CDCM, comprising a comprehensive needs assessment and individualized interventions by nurses specifically qualified for dementia care collaborating with GPs and health care stakeholders over 6 months. The control group received usual care.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Main outcomes were neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]), caregiver burden (Berlin Inventory of Caregivers\u2019 Burden in Dementia [BIZA-D]), health-related quality of life (HRQOL, measured by the Quality of Life in Alzheimer Disease scale and 12-Item Short-Form Health Survey [SF-12]), antidementia drug treatment, potentially inappropriate medication, and cost-effectiveness (incremental cost per quality-adjusted life year [QALY]) over 36 months. Outcomes between groups were compared using multivariate regression models adjusted for baseline scores.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 308 patients, of whom 221 (71.8%) received CDCM (mean [SD] age, 80.1 [5.3] years; 142 [64.3%] women) and 87 (28.2%) received usual care (mean [SD] age, 79.2 [4.5] years; 50 [57.5%] women), were included in the clinical effectiveness analyses, and 428 (303 [70.8%] CDCM, 125 [29.2%] usual care) were included in the cost-effectiveness analysis (which included 120 patients who had died). Participants receiving CDCM showed significantly fewer behavioral and psychological symptoms (adjusted mean difference [AMD] in NPI score, \u221210.26 [95% CI, \u221216.95 to \u22123.58]; P<\/jats:italic>\u2009=\u2009.003; Cohen d<\/jats:italic>, \u22120.78 [95% CI, \u22121.09 to \u22120.46]), better mental health (AMD in SF-12 Mental Component Summary score, 2.26 [95% CI, 0.31-4.21]; P<\/jats:italic>\u2009=\u2009.02; Cohen d<\/jats:italic>, 0.26 [95% CI, \u22120.11 to 0.51]), and lower caregiver burden (AMD in BIZA-D score, \u22120.59 [95% CI, \u22120.81 to \u22120.37]; P<\/jats:italic>\u2009&amp;lt;\u2009.001; Cohen d<\/jats:italic>, \u22120.71 [95% CI, \u22121.03 to \u22120.40]). There was no difference between the CDCM group and usual care group in use of antidementia drugs (adjusted odds ratio, 1.91 [95% CI, 0.96-3.77]; P<\/jats:italic>\u2009=\u2009.07; Cram\u00e9r V<\/jats:italic>, 0.12) after 36 months. There was no association with overall HRQOL, physical health, or use of potentially inappropriate medication. The CDCM group gained QALYs (0.137 [95% CI, 0.000 to 0.274]; P<\/jats:italic>\u2009=\u2009.049; Cohen d<\/jats:italic>, 0.20 [95% CI, \u22120.09 to 0.40]) but had no significant increase in costs (437\u20ac [\u22125438\u20ac to 6313\u20ac] [US $476 (95% CI, \u2212$5927 to $6881)]; P<\/jats:italic>\u2009=\u2009.87; Cohen d<\/jats:italic>, 0.07 [95% CI, \u22120.14 to 0.28]), resulting in a cost-effectiveness ratio of 3186\u20ac (US $3472) per QALY. Cost-effectiveness was significantly better for patients living alone (CDCM dominated, with lower costs and more QALYs gained) than for those living with a caregiver (47\u202f538\u20ac [US $51\u202f816] per QALY).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this secondary analysis of a cluster randomized clinical trial, CDCM was associated with improved patient, caregiver, and health system\u2013relevant outcomes over 36 months beyond the intervention period. Therefore, it should become a health policy priority to initiate translation of CDCM into routine care.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT01401582<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.19282","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T15:33:46Z","timestamp":1720193626000},"page":"e2419282","source":"Crossref","is-referenced-by-count":16,"title":["Clinical Outcomes and Cost-Effectiveness of Collaborative Dementia Care"],"prefix":"10.1001","volume":"7","author":[{"given":"Bernhard","family":"Michalowsky","sequence":"first","affiliation":[{"name":"German Center for Neurodegenerative Diseases (DZNE), Rostock\/Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Blotenberg","sequence":"additional","affiliation":[{"name":"German Center for Neurodegenerative Diseases (DZNE), Rostock\/Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Platen","sequence":"additional","affiliation":[{"name":"German Center for Neurodegenerative Diseases (DZNE), Rostock\/Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Teipel","sequence":"additional","affiliation":[{"name":"German Center for Neurodegenerative Diseases (DZNE), Rostock\/Greifswald, Rostock, Germany"},{"name":"Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Kilimann","sequence":"additional","affiliation":[{"name":"German Center for Neurodegenerative Diseases (DZNE), Rostock\/Greifswald, Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Portacolone","sequence":"additional","affiliation":[{"name":"Institute for Health & Aging, University of California, San Francisco"},{"name":"Philip R. 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