Purpose of the study
The purpose of the study was to assess the impact of a multi-component health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries and to establish if these outcomes differ by urban or rural residents. The study was conducted through a controlled trial that lasted for 22 months.
Sample and variables used in the study
Meng et al. (2009) used a sample of 766 elderly beneficiaries of Medicare from western New York, West Virginia and Ohio states. Out of the 766 participants, only 452 completed the 22-month follow-up assessment program. 234 of the 452 participants were in the control group while 218 were in the intervention group.
The dependent variables in the study were physical function and healthcare expenditures. Physical function was measured by the variations in self-reported reliance in activities of daily living such as bathing, grooming and feeding. Healthcare expenditures were computed by summing up the expenditures from different sources including local Medicare reimbursement rates, local healthcare provider charges and out of pocket fees.
Intervention
The intervention used in the study comprised of three elements:
- Patient education which was achieved through the provision of knowledge and skills of disease self-management by nurses;
- Coaching on individualized health promotion and disease self-management; and
- Physician care management.
Statistical procedures used
A number of statistical tests were used for different variables. The χ^sup 2^ test was used for the categorical variables to make comparisons between the baseline features of the intervention group and those of the control group. The t test was used for the continuous variables to make comparisons between the baseline features of the intervention group and those of the control group. The impact of the participants who failed to complete the 22-month follow-up assessment program was evaluated by comparing the baseline features of those who completed the program with those who did not complete it. The mean activities of daily living was computed and compared at baseline and after completion of the program by urban/rural status as well as by treatment. Ordinary least squares (OLS) regression analysis was used to approximate the impact of the intervention on variations in physical function while at the same time controlling for other covariates. A model was estimated that forecasted the relationship between the intervention variable and other covariates. Stratified analysis was then used to examine differences between the rural and urban residents. The R^sup 2^ was also used to assess the goodness of fit of the predicted model while the Pregibon’s link test was used to assess the specifications of the model (Meng et al., 2009).
Findings of the study
The measurement of the changes in physical function following the 22-month program showed that in general, participants experienced a decline in their physical function following the program. This was portrayed by an increase in the mean value of the activities for daily living dependencies over the course of the program. The participants in the intervention however experienced a smaller decline (.23) in their physical function as compared to the participants in the control group (.50). Comparing the physical change by intervention and urban-rural status showed that rural participants reported an improved performance in their physical function as compared to the urban participants. This is because the rural participants who were in the intervention group had an 81% reduction rate in the mean number of ADL dependencies while the urban participants in the intervention group had a 36% reduction rate (Meng et al., 2009).
Results from the ordinary least squares regression analysis showed that the coefficient estimate was (-0.27, p=.03) for the entire sample proving that intervention had a positive effect on minimizing functional decline. The intervention effect was however not statistically significant for the urban participants (coefficient estimate -0.09, p=.56). On the contrary, the intervention effect was statistically significant for the rural participants (coefficient estimate -0.57, p=.01) and it was more than double that of the entire sample.
The measure for the total health care expenditures showed that the average total healthcare expenditures were lower in the intervention group than in the control group during the 22-month follow-up assessment program. In the intervention group, the average total health care expenditures were $26,100 while in the control group the average health care expenditures were $29,200. This finding shows that the intervention program is cost effective even when the costs of delivering the intervention are taken into consideration (Meng et al., 2009).
Conclusion of the study
The findings of the study are consistent with other studies that have been carried out to examine the effectiveness of interventions among the elderly populations. For instance, Meng et al. (2009) state that, “Gill and colleagues (2002) found that a 6-month home-based physical therapy intervention resulted in a 37% reduction in functional decline among a sample of frail older adults aged 75 and older,” (p.415). The results of this study showed that the intervention helped to reduce the decline in physical function among the elderly people. The results also showed that the intervention was more successful in reducing physical decline among the rural participants than among the urban participants.
Appropriateness of the statistical tests
The statistical tests used in the study are appropriate in achieving the main objectives of the study. Because the study aimed at comparing the differences in the effect of intervention programs on the physical function and healthcare expenditures between the rural and urban elderly people, the scholars needed to use tests that would assess the existing differences. The tests used such as the t-test and OLS regression analysis helped to show these differences. In addition, the tests used helped to show the differences in the impact of the intervention program between the control and intervention groups. Lastly, the tests used helped to capture the effect of the intervention programs on the participants who failed to complete the 22-month follow-up assessment program. The credibility of the study was thus enhanced by using these statistical tests.
Reference List
Gill, T. M., Baker, D. I., Gottschalk, M., Peduzzi, P. N., Allore, H., & Byers, A. (2002). A program to prevent functional decline in physically frail, elderly persons who live at home. New England Journal of Medicine, 347, 1068-1074.
Meng, H., Wamsley, B., Liebel, D., Dixon, D., et al. (2009). Urban-rural differences in the effect of a Medicare Health Promotion and Disease Self-Management Program on physical function and health care expenditures. The Gerontologist, 49(3), 407-417.