ERIC Number: EJ840501
Record Type: Journal
Publication Date: 2009-Jun
Pages: 11
Abstractor: As Provided
ISBN: N/A
ISSN: ISSN-0016-9013
EISSN: N/A
Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures
Meng, Hongdao; Wamsley, Brenda; Liebel, Diane; Dixon, Denise; Eggert, Gerald; Van Nostrand, Joan
Gerontologist, v49 n3 p407-417 Jun 2009
Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence. Design and Methods: We analyzed data from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio. Physical function was measured by changes in self-reported dependencies in activities of daily living over the study period. Total health care expenditures were measured by aggregating expenditures from major sources (acute, postacute, and long-term care). We used ordinary least squares models to examine the effects of the intervention on both physical function and cost outcomes during the 22-month period. Results: The results indicated that the intervention reduced physical functional decline by 54% (p = 0.03) in the study sample. Stratified analyses showed that the intervention effect was much stronger in the rural sample. Mean total health care expenditures were 11% ($3,100, p = 0.30) lower in the intervention group. The effects of the intervention on average health care expenditures were similar among urban and rural participants. Implications: The intervention offered a promising strategy for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future studies need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population.
Descriptors: Expenditures, Intervention, Health Promotion, Diseases, Older Adults, Rural Urban Differences, Least Squares Statistics, Self Management, Health Services, Costs, Health Insurance, At Risk Persons, Physical Mobility, Physical Health
Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://gerontologist.oxfordjournals.org
Publication Type: Journal Articles; Reports - Research
Education Level: N/A
Audience: N/A
Language: English
Sponsor: N/A
Authoring Institution: N/A
Identifiers - Location: New York; Ohio; West Virginia
Grant or Contract Numbers: N/A