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Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

BACKGROUND: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could impro...

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Autores principales: Platen, Moritz, Fleßa, Steffen, Rädke, Anika, Wucherer, Diana, Thyrian, Jochen René, Mohr, Wiebke, Scharf, Annelie, Mühlichen, Franka, Hoffmann, Wolfgang, Michalowsky, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: IOS Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609693/
https://www.ncbi.nlm.nih.gov/pubmed/34459396
http://dx.doi.org/10.3233/JAD-210439
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author Platen, Moritz
Fleßa, Steffen
Rädke, Anika
Wucherer, Diana
Thyrian, Jochen René
Mohr, Wiebke
Scharf, Annelie
Mühlichen, Franka
Hoffmann, Wolfgang
Michalowsky, Bernhard
author_facet Platen, Moritz
Fleßa, Steffen
Rädke, Anika
Wucherer, Diana
Thyrian, Jochen René
Mohr, Wiebke
Scharf, Annelie
Mühlichen, Franka
Hoffmann, Wolfgang
Michalowsky, Bernhard
author_sort Platen, Moritz
collection PubMed
description BACKGROUND: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). OBJECTIVE: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. METHODS: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. RESULTS: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95% CI –0.14 – –0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95% CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. CONCLUSION: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia.
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spelling pubmed-86096932021-12-10 Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia Platen, Moritz Fleßa, Steffen Rädke, Anika Wucherer, Diana Thyrian, Jochen René Mohr, Wiebke Scharf, Annelie Mühlichen, Franka Hoffmann, Wolfgang Michalowsky, Bernhard J Alzheimers Dis Research Article BACKGROUND: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). OBJECTIVE: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. METHODS: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. RESULTS: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95% CI –0.14 – –0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95% CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. CONCLUSION: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia. IOS Press 2021-10-12 /pmc/articles/PMC8609693/ /pubmed/34459396 http://dx.doi.org/10.3233/JAD-210439 Text en © 2021 – The authors. Published by IOS Press https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Platen, Moritz
Fleßa, Steffen
Rädke, Anika
Wucherer, Diana
Thyrian, Jochen René
Mohr, Wiebke
Scharf, Annelie
Mühlichen, Franka
Hoffmann, Wolfgang
Michalowsky, Bernhard
Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title_full Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title_fullStr Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title_full_unstemmed Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title_short Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia
title_sort prevalence of low-value care and its associations with patient-centered outcomes in dementia
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8609693/
https://www.ncbi.nlm.nih.gov/pubmed/34459396
http://dx.doi.org/10.3233/JAD-210439
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