Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #112638

Ethan Corona, BA, Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, 585-273-2548, Ethan_Corona@urmc.rochester.edu, Bruce Friedman, PhD, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue, Box 644, Rochester, NY 14642, Brenda R. Wamsley, PhD, Executive Director, Center for Aging & Healthcare in West Virginia, 517 Market Street, Dils Building, Parkersburg, WV 26101, and Gerald Eggert, PhD, Executive Director, Monroe County Long Term Care Program, Inc, P.O. Box 429, East Rochester, NY 14445.

Ambulatory care sensitive (ACS) hospital admissions are hospitalizations that should be avoidable if the patient receives adequate primary care on a timely basis. The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial that tested the effectiveness of two models of consumer-directed care, a chronic disease self-management/health promotion Nurse intervention and a Voucher, plus their Combination, among Medicare beneficiaries who were functionally disabled and at increased risk for high healthcare costs. We hypothesized that the rate of ACS admissions would be lower in the Nurse and Combination groups than in the Control group because the patients in those groups should have had improved chronic disease self management and better communication with their primary care physicians. We also expected that the patients in the Voucher group would have a lower rate of admissions because the Voucher should have helped them better maintain their health status.

Methods: 18 ACS conditions selected by McCall (2004) were identified. Pearson's Chi Square test was used to examine the proportion of hospital admissions in each of the 4 groups that were due to ACS conditions.

Results: 302 (42.0%) of the 719 hospital admissions of the 449 rural patients were for ACS conditions. The proportion of all hospital admissions due to ACS conditions was about the same for each of the 3 intervention groups (23.5-26.5%) as for the Control group (24.5%) (p=.774).

Conclusion: Neither the Nurse, Voucher, or Combination interventions appear to have affected the proportion of hospital admissions due to ACS conditions.

Learning Objectives:

• The participants in the session will acquire information about why the proportion of ambulatory care sensitive hospital admissions of the rural patients in the Medicare Primary and Consumer-Directed Care Demonstration were expected to differ across the several interventions in the Demonstration.
• The participants in the session will be able to identify and describe why the number and proportion of ambulatory care sensitive hospital admissions were anticipated to differ by intervention.
• The participants in the session will be able to identify and describe why the number and proportion of ambulatory care sensitive hospital admissions did not differ across the 3 interventions and the Control group.
• The participants in the session will be able to identify reasons we believe were responsible for the absence of differences across the 3 interventions and the Control group.

Keywords: Consumer Direction, Medicare

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation