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J Am Geriatr Soc. 2019 Feb;67(2):363-370. doi: 10.1111/jgs.15713. Epub 2018 Dec 13.

Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function.

Author information

1
Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan.
2
Department of Psychiatry and Department of Statistics and Probability, Michigan State University, East Lansing, Michigan.
3
College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania.
4
School of Nursing, Johns Hopkins University, Baltimore, Maryland.

Abstract

BACKGROUND/OBJECTIVES:

Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction.

DESIGN:

A 3-year participatory, single-group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study.

SETTING:

Four Medicaid home and community-based waiver sites in Michigan.

PARTICIPANTS:

The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older.

INTERVENTION:

Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies.

MEASUREMENT:

Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE.

RESULTS:

Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P = .01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P < .01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P < .01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P = .03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P < .01) and hospitalizations (0.47 ± 2.66; P < .01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community.

CONCLUSION:

Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363-370, 2019.

KEYWORDS:

Medicaid waiver; adaptation; evidence-based model; implementation; physical function

PMID:
30548594
DOI:
10.1111/jgs.15713

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