The Gerontologist Advance Access published online on April 28, 2009
The Gerontologist, doi:10.1093/geront/gnp057
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Urban–Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures
2 Department of Social Work, West Virginia State University, Institute, West Virginia
3 School of Nursing, University of Rochester, Rochester, New York
4 University Hospital, State University of New York at Stony Brook, Stony Brook, New York
5 Monroe County Long Term Care Program, Inc., East Rochester, New York
6 Office of Rural Health Policy, Health Resources and Services Administration, DHHS, Rockville, Maryland
1 Address correspondence to Hongdao Meng, Department of Preventive Medicine, State University of New York at Stony Brook, HSC, Level 3, Rm071, NY 11794-8338. E-mail: hongdao.meng{at}stonybrook.edu
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Abstract |
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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 = .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 = .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.
Keywords: Health promotion, Disease management, Prevention, Expenditures, Rural
Received February 4, 2008; Accepted May 2, 2008