Long-term Impact of a Health Promotion Nurse Intervention on Functional Status and Costs among High Risk Medicare Beneficiaries

Functional decline in elderly persons contributes to increased mortality and morbidity. Studies have shown that occupational and physical therapy at home leads to improvement in physical functioning. We examined the effectiveness and cost of a multi-component health promotion nurse intervention in 452 high risk Medicare beneficiaries in urban and rural areas of upstate New York and West Virginia-Ohio border over 2 years. We measured self-reported dependencies in activities of daily living (ADL) and instrumental activities of daily living (IADL), and total health care expenditures. We used linear regression to estimate the effect of intervention on functional outcomes. We found that the intervention led to better maintenance of ADLs but not of IADLs (p=0.04 and p=0.27, respectively). When each component of the ADL (bathing, dressing, eating, toileting, transferring, and walking) was examined, we found that the intervention effect is primarily on bathing and toileting. We did not find any difference in the intervention effect among urban and rural participants. Average total health care expenditures were 9.9% ($2,965, 95% CI: -$7,979, $1,234) lower in the nurse group compared to the control group ($26,994 versus $29,959, respectively). We conclude that the health promotion nurse intervention maintain physical functioning while remaining cost neutral for high risk Medicare beneficiaries. Future studies should explore the mechanisms responsible for this effect and how to enhance the cost and effectiveness of community-based multi-component health promotion interventions.