School of Nursing, Johns Hopkins University, Baltimore, Maryland.
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
J Am Geriatr Soc. 2018 Mar;66(3):614-620. doi: 10.1111/jgs.15143. Epub 2017 Nov 22.
BACKGROUND/OBJECTIVES: Little is known about cost savings of programs that reduce disability in older adults. The objective was to determine whether the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program saves Medicaid more money than it costs to provide.
Single-arm clinical trial (N = 204) with a comparison group of individuals (N = 2,013) dually eligible for Medicaid and Medicare matched on baseline geographic and demographic characteristics, chronic conditions, and healthcare use. We used finite mixture model regression estimates in a Markov model.
Baltimore, MD PARTICIPANTS: Individuals aged 65 and older with reported difficulty with at least one activity of daily living.
CAPABLE is a 5-month program to reduce the health effects of impaired physical function in low-income older adults by addressing individual capacity and the home environment. CAPABLE uses an interprofessional team (occupational therapist, registered nurse, handyman) to help older adults attain self-identified functional goals.
Monthly average Medicaid expenditure and likelihood of high- or low-cost use of eight healthcare service categories.
Average Medicaid spending per CAPABLE participant was $867 less per month than that of their matched comparison counterparts (observation period average 17 months, range 1-31 months). The largest differential reduction in expenditures were for inpatient care and long-term services and supports.
CAPABLE is associated with lower likelihood of inpatient and long-term service use and lower overall Medicaid spending. The magnitude of reduced Medicaid spending could pay for CAPABLE delivery and provide further Medicaid program savings due to averted services use.
CAPABLE for Frail dually eligible older adults NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495.
背景/目的：对于能够减少老年人残疾的项目的成本节约情况，人们知之甚少。本研究旨在确定社区赋权以改善老年人生活（CAPABLE）项目是否比提供该项目的成本更能节省医疗补助资金。
对 204 名参与者进行单臂临床试验（N=204），并将符合医疗补助和医疗保险双重条件的 2013 名个体作为对照组进行比较，两组在基线地理和人口统计学特征、慢性病和医疗保健使用方面进行匹配。我们使用有限混合模型回归估计值在马尔可夫模型中进行分析。
马里兰州巴尔的摩市
报告存在至少一项日常生活活动困难的 65 岁及以上老年人。
CAPABLE 是一个为期 5 个月的项目，旨在通过解决个人能力和家庭环境问题来减少低收入老年人身体功能受损对健康的影响。CAPABLE 采用跨专业团队（职业治疗师、注册护士、杂工）帮助老年人实现自我确定的功能目标。
每月平均医疗补助支出和八种医疗服务类别的高或低成本使用的可能性。
CAPABLE 参与者的每月平均医疗补助支出比对照组低 867 美元（观察期平均为 17 个月，范围为 1-31 个月）。支出差异最大的是住院护理和长期服务和支持。
CAPABLE 与较低的住院和长期服务使用以及较低的总体医疗补助支出相关。医疗补助支出减少的幅度足以支付 CAPABLE 的提供费用，并由于避免了服务使用而进一步为医疗补助计划节省资金。
适合虚弱的双重合格老年人的 CAPABLE NCT01743495 https://clinicaltrials.gov/ct2/show/NCT01743495。
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