The 130th Annual Meeting of APHA

Abstract #38255

Dana B. Mukamel¹, Derick Peterson², Alina Bajorska³, Helena Temkin-Greener, PhD¹, Stephen Kunitz, MD, PhD¹, T. Franklin Williams, MD⁴, and Diane Gross, PhD¹. (1) Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (716) 275-1985, dana_mukamel@urmc.rochester.edu, (2) Department of Biostatistics, University of Rochester, 601 Elmwood Avenue, Box 630, Rochester, NY 14642, (3) Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (4) Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620

PACE is a managed care program for frail elderly individuals. It provides primary, acute and long-term care services and its objective is to maintain the independence of participants in the community. PACE sites follow similar care protocols with similar care objectives, thus leading to the expectation that risk adjusted health outcomes will also be similar across sites. In this study we investigated the variation in risk adjusted health outcomes of participants in different sites. Participant level data from 28 PACE sites were used to develop three risk adjustment models: for mortality, changes in functional status and changes in self assessed health. These models included both participant level risk factors and site indicator variables. The coefficients of the site variables can be used to rank sites performance with respect to each outcome. We found significant variation in risk adjusted health outcomes across sites. For example, the relative hazard of the worst to the best site is 19 (2.47 vs 0.13). There was no correlation between site rankings based on the different risk adjusted outcomes suggesting that excellence in one outcome does not imply excellence in another outcome. This study demonstrates that despite the similarity in care objective and care protocols, PACE sites differ in the outcomes their participants experience. The variation we observe indicates that there is room for improvements in quality of care.

Learning Objectives:

Particiapnts will
• develop knowledge in the use of risk adjusted health outcomes as measures of quality
• will gain knowledge of the experience of the PACE progrmas in terms of risk adjusted health outcomes

Keywords: Quality of Care,

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.