Abstract

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.

中文翻译：

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低价值护理的流行及其与以患者为中心的痴呆症结果的关联

摘要

背景：

低价值护理 (LvC) 被定义为在患者偏好、潜在危害、成本或可用替代方案方面不太可能为患者带来益处的护理。避免 LvC 并推广推荐的循证治疗，称为高价值护理 (HvC)，可以改善患者报告的痴呆症患者 (PwD) 的结果。

客观的：

本研究旨在确定痴呆中 LvC 和 HvC 的患病率以及 LvC 和 HvC 与患者生活质量和住院治疗的关联。

方法：

该分析基于 DelpHi 试验的数据，包括 516 名 PwD。痴呆症特定指南、“明智选择”活动和 PRISCUS 列表用于指示 LvC 和 HvC 治疗，从而产生 347 项 LvC 和 HvC 相关建议。其中，77 条建议（51 条用于 LvC，26 条用于 HvC）在 DelpHi 试验中进行了测量，并最终用于此分析。使用多元回归模型评估 LvC 和 HvC 治疗与 PwD 健康相关生活质量 (HRQoL) 和住院的关联。

结果：

LvC 在 PwD 中非常普遍（31%）。接受 LvC 的 PwD 的生活质量显着降低（b  = –0.07；95%CI –0.14––0.01）并且住院的可能性明显更高（OR = 2.06；95%CI 1.26–3.39）。不同的 HvC 治疗与 HRQoL 的正负变化相关。

结论：

LvC 可能会导致不良后果，应尽早发现并尝试更换。未来的研究应该检查支持识别和替代痴呆症 LvC 的护理或治疗途径的创新模型。