Oral

his is a Symposium with 5 papers. The Moderator is Gerald M. Eggert,PhD. The Discussant is Joan F. Van Nostrand,DPA, Director of Research, Office of Rural Health Policy, HRS/DHHS. A recently concluded RCT of consumer-directed self care strategies found that frail Medicare beneficiaries who lived in rural areas maintained their functional (ADL) status better than those who lived in urban areas. While Medicare paid more for those in the treatment group, the difference was not significant. All other costs (Private pay primarily, but some Medicaid and VA) were lower, but not significantly so. The CMS funded study enrolled 1,604 disabled Medicare beneficiaries from primary care practises in rural and urban parts of WV, OH, and upstate NY. Dr. Brenda Wamsley will give an overview of the study. Dr. Hongdao Ming will report the results of the Health Promotion Nurse intervention on subjects with diabetes or who were at high risk of developing diabetes. Dr. Bruce Friedman will present the results of the Nurse intervention on Medicare beneficiaries with depression. Dr. Meng will then identify components of the 6 point ADL scale that participants were able to maintain or improve on over the 22 months. Ms. Dianne Liebel will identify the components of the Nurse's practise that were related to positive participant outcomes. Dr. Joan Van Nostrand will discuss the possibilities of replicating the Nurse model. Audience participation will be sought.

Session Objectives: * Participants will learn how an Health Promotion Nurse affiliated with a primary care physician was able to help disabled Medicare beneficiaries with diabetes, heart conditions and depression maintain function over a 22 month period. * Participants will be able to identify the components of the Nurse's practise that led to maintaining function. * Participants will develop an understanding of the cost of maintaining function to Medicare and other payers. * Participants will be able to develop an understanding of the key policy issues in replicating this model. * Individual papers contain more specific learning objectives.

CE Credits: CME, Health Education (CHES), Nursing