Send to

Choose Destination
See comment in PubMed Commons below
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

Department of Preventive Medicine, State University of New York at Stony Brook, HSC, NY 11794-8338, USA.



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.


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.


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.


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.

[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Support Center