• Geertje van de Ven, Irena Draskovic, Elke van Herpen, Raymond T C M Koopmans, Rogier Donders, Sytse U Zuidema, Eddy M M Adang, and Myrra J F J Vernooij-Dassen.
• Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands ; Radboud Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, The Netherlands.
• Plos One. 2014 Jan 1; 9 (1): e86662.

BackgroundDementia-care mapping (DCM) is a cyclic intervention aiming at reducing neuropsychiatric symptoms in people with dementia in nursing homes. Alongside an 18-month cluster-randomized controlled trial in which we studied the effectiveness of DCM on residents and staff outcomes, we investigated differences in costs of care between DCM and usual care in nursing homes.MethodsDementia special care units were randomly assigned to DCM or usual care. Nurses from the intervention care homes received DCM training, a DCM organizational briefing day and conducted the 4-months DCM-intervention twice during the study. A single DCM cycle consists of observation, feedback to the staff, and action plans for the residents. We measured costs related to health care consumption, falls and psychotropic drug use at the resident level and absenteeism at the staff level. Data were extracted from resident files and the nursing home records. Prizes were determined using the Dutch manual of health care cost and the cost prices delivered by a pharmacy and a nursing home. Total costs were evaluated by means of linear mixed-effect models for longitudinal data, with the unit as a random effect to correct for dependencies within units.Results34 units from 11 nursing homes, including 318 residents and 376 nursing staff members participated in the cost analyses. Analyses showed no difference in total costs. However certain changes within costs could be noticed. The intervention group showed lower costs associated with outpatient hospital appointments over time (p = 0.05) than the control group. In both groups, the number of falls, costs associated with the elderly-care physician and nurse practitioner increased equally during the study (p<0.02).ConclusionsDCM is a cost-neutral intervention. It effectively reduces outpatient hospital appointments compared to usual care. Other considerations than costs, such as nursing homes' preferences, may determine whether they adopt the DCM method.Trial RegistrationDutch Trials Registry NTR2314.

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