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NRI 97-022 – HSR&D Study

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NRI 97-022
Outcomes Assessment for Dementia Care: Development of a Module
Marisue Cody PhD RN MPA
Central Arkansas Veterans Healthcare System Eugene J. Towbin Healthcare Center, Little Rock, AR
No. Little Rock, AR
Funding Period: August 1998 - June 2002

BACKGROUND/RATIONALE:
Within the next decade, the aging veterans will have a dramatic effect on the VA health care system. The number of veterans with dementia, a common disease of the aged, will increase with the growth in the number of veterans 75 and older. With the VA striving toward increasing productivity and providing “best value” health care, the effectiveness of services and treatments for persons with dementia needs evaluation. Currently, there are no standardized measurement packages permitting meaningful and informative comparisons of data from independent assessments of treatment effectiveness.

OBJECTIVE(S):
The long-term goal of this research is to improve treatment of veterans with dementia by providing reliable, valid information about the outcomes of VA services.

METHODS:
The steps of module development included a critical review of the literature, convening an expert panel, drafting the items for the module, reviewing and revising the module draft, and field testing the module. The study was carried out in two phases. Phase 1 (1st year) was the development of the prototype OMMI. Phase II (2 ½ years) was the field test of the OMMI. The field test used two samples: a test-retest sample to evaluate reliability and a longitudinal sample to examine cross-sectional relationships and change over time within and between subjects.

FINDINGS/RESULTS:
The outcome domains measured by the OMMI were cognition, function, behavior, quality of life, caregiver health and burden, and satisfaction with care. The test-retest sample included 59 dyads. The longitudinal sample included 112 dyads. The samples were 64% female, 89% Caucasian, mean age 78. We used validated scales for all but two domains. We used the 5-item Geriatric Depression Scale (GDS) and validated it with the 30-item GDS. We adapted the Neuropsychiatric Inventory (NPI) and validated it against the full NPI. All scales had acceptable test-retest reliability, intraclass correlation coefficients ranged from 0.53 to 0.96. 5-item GDS results were significantly different from 30-item GDS results (c2=27). The short NPI correlated strongly (0.79) with the full NPI. Cognition and function were shown to decline over the six months with change scores similar to published studies.

IMPACT:
The module offers a method for monitoring outcomes of patients with dementia in routine settings. As the VA develops new programs, implements practice guidelines, and moves patients from specialty to primary care, aggregate patient data that focuses on outcomes of care for persons with dementia will be valuable in evaluating the cost-effectiveness of such changes.

PUBLICATIONS:

Journal Articles

  1. Beck C, Cody M, Souder E, Zhang M, Small GW. Dementia diagnostic guidelines: methodologies, results, and implementation costs. Journal of the American Geriatrics Society. 2000 Oct 1; 48(10):1195-203.
Conference Presentations

  1. Beck CK, Cody M, Fischer E, Liem PH, Stewart S, Wright P. Outcomes assessment for the memory impaired. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 2002 Nov 15; Boston, MA.
  2. Cody M. Coping abilities and role overload in family caregivers to cognitively impaired seniors. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 1999 Nov 20; San Francisco, CA.
  3. Frank L, Cody M. Dementia diagnosis in the Veteran's Administration: What does it mean? Presented at: VA HSR&D National Meeting; 1999 Sep 15; Washington, DC.
  4. Beck C, Cody M, Souder E, Zhang M. Dementia Guidelines: Proliferation, ambiguity, and costs of implementation. Paper presented at: Gerontological Society of America Annual Scientific Meeting; 1998 Nov 15; Philadelphia, PA.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Treatment - Observational
Keywords: Dementia, Nursing, Research measure
MeSH Terms: Dementia, Outcome Assessment (Health Care), Nursing

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