Finally, we offer directions for future growth to advance ePCTs for ACP among PLWD and catalyze future research. Specifically, we consider how potential challenges were overcome by tradeoffs in study design. These considerations are weighed in further detail by describing the approaches from three published trials. We outline specific considerations at each step of the research study process including (1) participant identification/eligibility, (2) participant recruitment/enrollment, (3) intervention implementation, and (4) outcome selection/ascertainment. Here we describe a framework for the construction of these research studies, with a focus on distinguishing between the target of study: the PLWD, their care partners, or both. However rigorous conduct of ePCTs of ACP for PLWD presents several unique methodological considerations. Embedded pragmatic clinical trials (ePCTs) may facilitate the uptake of evidence-based care into existing healthcare by deploying efficacious ACP interventions into real-world settings. While many trials have established the efficacy of ACP in improving end-of-life communication and documentation of care preferences, there remains a gap in clinical usage. Online ahead of print.Īdvance care planning (ACP) is an important part of comprehensive care for persons living with dementia (PLWD). New paper published! Design Considerations for Embedded Pragmatic Clinical Trials of Advance Care Planning Interventions for Persons Living with Dementia PMID:36630699 | DOI:10.1093/gerona/glad010Ĭhange in a Claims-Based Frailty Index, Mortality, and Healthcare Costs in Medicare Beneficiaries - PubMed The mean total Medicare cost per member per year (standard deviation) was from $12,149 ($83,508) in non-frail beneficiaries to $61,155 ($345,904) in moderate-to-severely frail beneficiaries.ĬONCLUSION: One-year changes in CFI are associated with elevated mortality risk and healthcare costs across all levels of frailty. RESULTS: The study population included 995,664 beneficiaries (mean age 77 years, 56.8% female). We used Cox proportional hazards model to estimate hazard ratio (HR) for mortality adjusting for age, sex, and 2015 CFI value and compared total Medicare costs from Januand December 31, 2016. METHODS: We used a 5% sample of fee-for-service Medicare beneficiaries. Our objective was to examine the association of changes in CFI over 12 months with mortality and Medicare costs. Online ahead of print.īACKGROUND: A claims-based frailty index (CFI) allows measurement of frailty on a population scale. New paper published! Change in a Claims-Based Frailty Index, Mortality, and Healthcare Costs in Medicare Beneficiaries
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