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Collaborative care management reduces disparities in dementia care quality for caregivers with less education


Brown, Arleen F., Vassar, Stefanie D., Connor, Karen I., Vickrey, Barbara G.


Journal Of The American Geriatrics Society, Volume: 61, No.: 2, Pages.: 243-251

Year of Publication



Objectives: To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver.; Design: Analysis of data from a cluster-randomized controlled trial.; Setting: Eighteen clinics in three healthcare organizations in southern California.; Participants: Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver.; Intervention: Collaborative care management for dementia.; Measurements: Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants.; Results: At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P < .001 for all three).; Conclusions: Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education.; © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Bibtex Citation

@article{Brown_2013, doi = {10.1111/jgs.12079}, url = {}, year = 2013, month = {jan}, publisher = {Wiley-Blackwell}, volume = {61}, number = {2}, pages = {243--251}, author = {Arleen F. Brown and Stefanie D. Vassar and Karen I. Connor and Barbara G. Vickrey}, title = {Collaborative Care Management Reduces Disparities in Dementia Care Quality for Caregivers with Less Education}, journal = {Journal of the American Geriatrics Society} }


adherence, aged, by, california, care, caregivers, carers, cooperative behavior, dementia, education, female, guideline adherence, guidelines, humans, informal, male, medicare, on, outcome assessment (health care), primary health care, quality of health care, recommended, standards, therapy, to, united states

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

Satisfaction with care/services


Hospital Outpatient Care

Type of Interventions

Intervention for Carers, Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Case management / Care navigator

Carer Focussed Interventions