Impact of a Disease Management-Health Promotion Nurse Intervention on Personal Assistance Use and Expenditures

Abstract

The purpose of this study is to evaluate the effect of a primary care affiliated disease management-health promotion nurse intervention on paid personal assistance (PA) use and expenditures among Medicare beneficiaries with disabilities. We analyzed data on 570 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the Medicare Primary and Consumer-Directed Care Demonstration, a randomized controlled trial. We estimated a two-part model to test the effect of the nurse intervention on PA use and expenditures during the 2 years after study entry. Adjusting for covariates, average annual PA expenditures were $1,464 (29%) lower per person in the intervention group as compared to the control group. The findings of this study will help policy makers and practitioners understand the potential benefit of primary care affiliated nurse home visiting interventions on PA expenditures.

KEYWORDS:

• cost
• health promotion
• Medicare
• personal assistance

The authors thank two anonymous reviewers for their insightful comments and suggestions on the earlier version of this article. The data used in this article were collected as part of a Medicare Demonstration, “A Randomized Controlled Trial of Primary and Consumer-Directed Care for People with Chronic Illnesses” (CMS # 95-C-90467/2-01, Project Officers: Carolyn M. Rimes, Tamara Jackson-Douglas, and Don Sherwood).