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Gerontologist. 2009 Jun;49(3):407-17. doi: 10.1093/geront/gnp057. Epub 2009 Apr 28.

Urban-rural differences in the effect of a Medicare health promotion and disease self-management program on physical function and health care expenditures.

Author information

1
Department of Preventive Medicine, State University of New York at Stony Brook, HSC, NY 11794-8338, USA. hongdao.meng@stonybrook.edu

Abstract

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.

PMID:
19401357
PMCID:
PMC2782241
DOI:
10.1093/geront/gnp057
[Indexed for MEDLINE]
Free PMC Article
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