192887 A Program of All-Inclusive Care For Elderly Improves Five-Year Survival Compared to Alternative Home- and Community-Based Care

Sunday, November 8, 2009

G. Darryl Wieland, PhD, MPH , Geriatrics Services, Palmetto Health Richland, Columbia, SC
Rebecca Boland, MA , Geriatrics Services, Palmetto Health Richland, Columbia, SC
Bruce Kinosian, MD , Center for Health Equity Research and Promotion, Philadelphia VAMC, Philadelphia, PA
Community-based care is preferred to nursing-homes [NH] for people needing long-term care [LTC]. Community-based care under waiver [HCB] is widely available, while PACE is an option in 30 states. PACE is prepaid, capitated, comprehensive care integrated by center-based teams. We assess five-year survival of PACE v. HCB and NH entrants, controlling for mortality risk. Subjects (n= 2081) were residents of two SC counties admitted 1998-2003 to HCB, PACE and NH. Data were derived from state and program assessments, utilization and vital records. Subjects were followed until death or 5-year survival; those lost for the event or surviving < 5 yrs on 8/8/2005 were censored. Analyses included admission contrasts, and event curves tested with log-rank statistics. Mortality risk was assessed by the PPI (Carey et al. JAGS 2008; 56: 68-75). Mortality risk for PACE (72.6% “high-to-intermediate”) was greater than for HCB (58.8%), comparable to NH admissions (71.6%). NH median survival was 2.3 years. PACE median survival was 4.2 years, v. 3.5 in HCB (log rank= .394; p=0.53). With stratification, the PACE advantage over HCB is significant (log rank = 5.941; p=0.015). Intermediate and high risk admissions are most likely to benefit (intermediate risk: PACE median survival = 4.7 years v. HCB 3.4 years; high risk: PACE 3.1 v. HCB 2.0 years). Adjusting for risk, PACE produced a substantial survival advantage compared to HCB. That the benefit is most apparent in the ≥ intermediate-risk suggests the particular importance of integrated, team care for the older, disabled participants more commonly admitted to PACE.

Learning Objectives:
Describe long-term survival differences between risk-adjusted home- and community-based waiver program and PACE admissions.

Keywords: Long-Term Care, Frail Elderly

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a geriatrics services researcher with 25+ years of experience and am the PI of the project from which the paper is derived.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Palmetto Health Richland SC PACE (Richland is the parent organization) Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.