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APHA Scientific Session and Event Listing

Hongdao Meng, PhD, Preventive Medicine, State University of New York at Stony Brook, Health Sciences Center, Level 3, Room 071, Stony Brook, NY 11794-8338, 631-444-7281, hongdao.meng@stonybrook.edu, Brenda R. Wamsley, PhD, Department of Social Work, West Virginia State University, 928 Wallace Hall, P.O. Box 1000, Institute, WV 25112, Bruce Friedman, PhD, MPH, Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue Box 644, Rochester, NY 14642, and Gerald Eggert, PhD, Rural Health Consultant, 28 Lawton Street, Rochester, NY 14607.

Heart disease remains one of the major causes of mortality and morbidity in the U.S. It is the most frequently initial diagnosis for hospital discharge nationally among elderly Medicare beneficiaries. We tested the effectiveness of a health promotion/disease-management nurse intervention among Medicare beneficiaries with functional disabilities. This study examined the effect of the nurse intervention on functional outcomes and health care expenditures. The study sample consists of 310 participants (159 from the control group, 151 from the nurse group) who reported having at least one heart condition at baseline and who completed the two-year follow-up. Linear regression models were used to evaluate the effect of the intervention on the number of ADL disabilities and total health care expenditures, controlling for baseline characteristics (sociodemographics, health/functional status, and prior health care use). We found that participants in the nurse group had fewer functional disabilities than those in the control group (p=0.04). The intervention effect is stronger in rural area than in urban area, but it did not reach statistical significance (p=0.17). Average total health care expenditures were also lower in the nurse group for both urban and rural participants but not significantly so (p=0.33 and p=0.91, respectively). Multivariate regression model adjusting for covariates shows similar results. We conclude that the nurse intervention was able to delay functional decline while remaining cost neutral for high risk Medicare beneficiaries with heart conditions. Policy implications for urban and rural areas will be discussed.

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