Results of a Process Evaluation of a Nurse Home Visiting Intervention

Since the vast majority of older adults experiencing and recovering from disability prefer to live in the community nurse home visiting offers an effective method to deliver targeted geriatric strategies to improve measures of disability and promote health. The nurse intervention of the recently concluded Medicare Primary and Consumer-Directed Care Demonstration is one of only seven nurse home visiting studies that have reported positive disability outcomes for community dwelling elders with disability. A process evaluation of this intervention was completed in order to determine which components of the nurse intervention were most related to maintenance of function (ADL status). Outcomes were assessed using data from the nurse notes, case studies, and Demonstration databases. Results showed high levels of participation, dose, and fidelity for the intervention components. The results of the logistic regression (predict the change in ADL disability; maintenance/improvement vs. worsening) suggested that the intervention components most related to change in disability status were the frequency and intensity of nurse contact (p=.009), presence of family confernence visits with the physician (p=.064), actively working with the patient on disease (p=.042) and medication management (p=.019), and setting behavioral goals/objectives (p= .026). Sub-group analyses further demonstrated that patients who lived in rural areas maintained their functional status better than their urban conterparts. Additional analysis of the nurse intervention among this group will be presented delineating the specific intervention components responsible for the increased maintenance of disability among rural patients. Future intervention and research focus of home visiting in rural communities will be discussed.