Do disabled elderly Medicare beneficiaries with major depression make less use of a consumer-directed home care voucher benefit?

Older adults with major depression may underutilize consumer-directed long-term care. Systematic underutilization would create disparities in outcomes, undermining program effectiveness. The Medicare Primary and Consumer-Directed Care Demonstration included a consumer-directed indemnity benefit that paid for goods and services not financed by traditional Medicare.

Measurement bias of the SF-36 Health Survey in older adults with chronic conditions.

Purpose: The objectives of this study were to investigate the psychometric properties of the SF-36 in a sample of older adults with chronic conditions and to test whether measurement bias exists based on the levels of comorbidity.

Methods: Participants included were 979 cognitively intact older adults with comorbidities who were interviewed at their homes. We examined the psychometric properties of the SF-36 and conducted confirmatory factor analysis (CFA) to investigate the assumption of measurement invariance by the levels of comorbidity.

Body mass index and the impact of a health promotion intervention on health services use and expenditures.

Objective: To examine the effect of body mass index (BMI) on the impact of a health promotion intervention on health services use and expenditures among Medicare beneficiaries with disabilities.

Method: We analyzed data from 452 Medicare beneficiaries who participated in a Medicare demonstration. The intervention included the following components: patient education, health promotion coaching, medication management, and physician care management.

Choice of personal assistance services providers by medicare beneficiaries using a consumer-directed benefit: rural-urban differences.

Purpose: To examine the impact of an experimental consumer-choice voucher benefit on the selection of independent and agency personal assistance services (PAS) providers among rural and urban Medicare beneficiaries with disabilities.

Methods: The Medicare Primary and Consumer-Directed Care Demonstration enrolled 1,605 Medicare beneficiaries in 19 counties in New York State, West Virginia, and Ohio. A total of 839 participants were randomly assigned to receive a voucher benefit (up to $250 per month with a 20% copayment) that could be used toward PAS provided by either independent or agency workers.

Impact of body mass index on the effectiveness of a disease management-health promotion intervention on disability status.

Purpose: To examine the impact of body mass index (BMI) on the effectiveness of a disease management-health promotion intervention among community-dwelling Medicare beneficiaries with disabilities.

Design: Secondary data analyses of a randomized controlled trial.

Settings: Nineteen counties in upstate New York and on the West Virginia-Ohio border.

Patient satisfaction, empowerment, and health and disability status effects of a disease management-health promotion nurse intervention among Medicare beneficiaries with disabilities.

Purpose: To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care-affiliated disease self-management-health promotion nurse intervention for Medicare beneficiaries with disabilities and recent significant health services use.

Design And Methods: The Medicare Primary and Consumer-Directed Care Demonstration was a 24-month randomized controlled trial that included a nurse intervention. The present study (N = 766) compares the nurse (n = 382) and control (n = 384) groups.

Urban-rural differences in the effect of a Medicare health promotion and disease self-management program on physical function and health care expenditures.

Purpose: To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence.

Design And Methods: We analyzed data from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio.

Impact of a disease management-health promotion nurse intervention on personal assistance use and expenditures.

The purpose of this study is to evaluate the effect of a primary care affiliated disease management-health promotion nurse intervention on paid personal assistance (PA) use and expenditures among Medicare beneficiaries with disabilities. We analyzed data on 570 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the Medicare Primary and Consumer-Directed Care Demonstration, a randomized controlled trial. We estimated a two-part model to test the effect of the nurse intervention on PA use and expenditures during the 2 years after study entry.

Impact of a health promotion nurse intervention on disability and health care costs among elderly adults with heart conditions.

Context: Patients with heart conditions in rural areas may have different responses to health promotion-disease Self-management interventions compared to their urban counterparts.

Purpose: To estimate the impact of a multi-component health promotion nurse intervention on physical function and total health care expenditures among elderly adults with heart conditions and to examine the impact of rural residence on the intervention effect.

Methods: We analyzed data on 281 community-living Medicare beneficiaries with heart conditions from the Medicare Primary and Consumer-Directed Care Demonstration (a randomized controlled trial).

Effect of a voucher benefit on the demand for paid personal assistance.

Purpose: We estimated the effect of a voucher benefit on the demand for personal assistance by Medicare beneficiaries aged 65 years or older who had functional disabilities.

Design And Methods: We performed a secondary data analysis on 645 Medicare beneficiaries from the Medicare Primary and Consumer-Directed Care Demonstration (a randomized controlled trial) between August 1998 and June 2000. We estimated a two-part model to determine the effect of the voucher on out-of-pocket personal assistance expenditures.

Effect of a consumer-directed voucher and a disease-management-health-promotion nurse intervention on home care use.

Purpose: We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management-health-promotion nurse intervention, on the probability of use of two types of home care-skilled home health care and personal assistance services-received by functionally impaired Medicare beneficiaries.

Design And Methods: The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial in 19 counties in New York, West Virginia, and Ohio with four groups: disease-management-health-promotion nurse, consumer-directed voucher, combination (nurse plus voucher), and control. We estimated a bivariate probit model for the 1,394 individuals aged 65 or older who had no private long-term-care insurance.