The 130th Annual Meeting of APHA

Abstract #47922

Bruce Friedman, PhD, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, (585) 273-2618, Bruce_Friedman@urmc.rochester.edu, Brenda Wamsley, MSW, Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, Jurgis Karuza, PhD, Finger Lakes Geriatric Education Center, University of Rochester, Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620, and Gerald M. Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc./ACCESS, 349 West Commercial Street, Suite 2250, East Rochester, NY 14445.

The purpose of the Medicare Primary and Consumer-Directed Care Demonstration is to test the acceptability and effectiveness of three models of consumer-directed care in a population of Medicare beneficiaries who are functionally disabled and at increased risk for hospitalization. Participants were randomly assigned to one of four groups: (1) a Voucher for in-home services and equipment, (2) a Health Promotion Nurse (HPN) intervention, (3) the Voucher plus the HPN (the Combination group), and (4) the Control Group. About 1,000 of the 1,609 participants who began the Demonstration are expected to complete it. (Approximately 400 are expected to die and another 200 to drop out.) The design of consumer-directed care models is rooted in empowerment theory. The Voucher intervention enables consumers to increase control of managing their own home care services by hiring (and firing) in-home workers and purchasing supplies and equipment. The HPN intervention is based on the logic that empowering and teaching older adults with chronic illness how to better manage their own health and interact more effectively with health practitioners will result in better outcomes. Our first hypothesis is that the three intervention groups will exhibit higher levels of patient empowerment than the Control group at 22 months post-baseline as measured by the Multidimensional Health Locus of Control scales, a general self-efficacy scale, and specific empowerment questions developed for the Demonstration. Our second hypothesis is that the three intervention groups will have experienced greater increases in these measures between baseline and 22 months post-baseline than the Control group.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will understand the extent to which three models of consumer-directed care (Voucher, Health Promotion Nurse [HPN], and Voucher plus HPN) affected patient empowerment among functionally impaired Medicare beneficiaries at high risk of hospitalization.

Keywords: Consumer Direction, Medicare

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: During the past 3 years I was paid by the Monroe County Long Term Care Program to work on the Demonstration and the evaluation.