The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66259

Brenda Wamsley, MSW¹, Jurgis Karuza, PhD², Bruce Friedman, PhD³, and Hongdao Meng, MPH³. (1) Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, 304-422-2853, bwamsley@cah-wv.org, (2) Finger Lakes Geriatric Education Center, University of Rochester, Monroe Community Hospital, 435 East Henrietta Road, Rochester, NY 14620, (3) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642

Residents of rural areas may have higher levels of inactivity and functional impairment than their counterparts in urban areas. CMS funded a large (N=1,605) randomized trail of a primary care/health promotion nurse intervention conducted with a medically vulnerable and frail Medicare population in Western NY (N=1,083) and the Mid-Ohio Valley Region of WV/OH (N=522). The non-SMSA (rural) group was N=451. Results indicate a significant treatment effect in slowing functional decline among subjects in rural areas who completed the 24-month intervention. Participants in non-SMSA areas who received the primary care/health promotion nurse reported (-1.14) fewer limitations on a 12-point scale (p=.005) controlling for baseline ADL and other factors. The outcome of reduced functional decline was particularly strong (-1.87; p=.0001) in the WV/OH sample (N=522) but also significant in the NY sample (-0.86; p=.04). An overview of the intervention will be presented along with key factors that may have accounted for the differential impact with Medicare beneficiaries who lived in rural areas. Implications for rural primary care delivery will be discussed.

Learning Objectives:

At the conclusion of the sessions, the participant will be able to:
• Recognize that disease self-management interventions may work differently in rural and urban areas;
• Articulate the components of the primary care/nurse intervention that seemed to work best in rural areas;
• Understand the relevance of the outcomes for Medicare modernization in rural areas.

Keywords: Medicare, Disease Management

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.