Rural analyses of data from a Medicare demonstration: Overview and conceptual framework

This paper presents an overview of the key components of the Medicare Primary and Consumer-Directed Care Demonstration (N=1,604), a CMS-funded study conducted in WV, NY and OH with beneficiaries identified as having moderate to severe functional impairment. A conceptual framework is provided with special attention to a health promotion nurse/disease self-management intervention (Nurse Group). A definition of rural is provided along with key characteristics of rural Medicare beneficiaries. A brief summary of earlier findings of rural analyses is reviewed as background for the new findings being presented in this Symposium. Earlier findings showed that rural participants in the Nurse Group reported significantly less decline in activities of daily living (ADLS) compared to controls (p=0.02). This finding held when looking at rural sub-groups, such as those with heart conditions (p=0.04) and those with hypertension (p=0.07). Similar findings were not found in the urban sample. A summary of earlier findings related to cost and service use patterns is also provided as further background for the papers that will follow this overview and introduction.