Effects of comprehensive, individualized, person‐centered care on the relative risks of hospitalization and emergency department visits in community‐dwelling persons with advanced Alzheimer’s Disease in a 52‐week randomized controlled trial
Bibliographic record
Abstract
Abstract Background Rates of hospitalization are 3 times higher for community‐dwelling Alzheimer’s disease (AD) persons than non‐affected, age‐matched persons (Rudolph et al., J Am Geriatr Soc. 2010). These investigators reported that hospital outcomes were significantly worse for AD patients regarding delirium, prolonged length of stay, institutionalization and death. They concluded, “Given the frequency of hospitalization in …[AD]… patients, an intervention to prevent or shorten hospitalization would potentially save Medicare billions of dollars per year.” We conducted 28‐week, controlled, clinician‐blind, parallel group and 24‐week extension studies in which advanced AD persons were randomized to receive a comprehensive, individualized, person‐centered management program (CI‐PCM) developed by Sunnie Kenowsky and memantine or usual community care (UCC) and memantine (Reisberg…Kenowsky, Dement Geriatr Cogn Disord., 2017). Herein, we investigate the occurrence of hospitalization and emergency department visits (EDV) in the two groups at 52‐weeks. Methods Each occurrence of death, hospitalization and EDV was documented. Investigators blind to group assignment analyzed occurrences. Any fraction of a hospital stay or EDV occurring on or between the baseline and week 52 visit days was recorded as one incident. Relative Risk Reduction (RRR) was calculated for the incidence of hospitalization and EDV. Results 40% of UCC subjects experienced EDV, 40% were hospitalized and 10% died. Comparatively, only 10% of CI‐PCM subjects experienced EDV and 10% were hospitalized. UCC subjects were hospitalized for C. difficile infection, a fall and subsequent pelvic fracture, syncope and gastrointestinal disease. One CI‐PCM subject was hospitalized for a fall and hip fracture secondary to osteoporosis. UCC subject falls were attributed to neuropsychiatric symptoms of dementia. A CI‐PCM subject had C. difficile successfully treated by their physician. The RRR for utilization of the CI‐PCM program was 0.75 for EDV and 0.75 for hospitalizations (Tables 1&2). Conclusions CI‐PCM subjects had a 75% decreased risk of EDV and a 75% decreased risk of hospitalization. Given the 5.8 million USA AD persons and the current high cost of hospitalization, the CI‐PCM program could potentially, significantly decrease the costs of care for AD persons, Medicare, and Medicaid while greatly increasing the AD person’s quality of life and alleviating their caregiver’s burden.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".