Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA.
Scripps Gerontology Center, Miami University, Oxford, OH.
Med Care. 2021 Mar 1;59(3):273-279. doi: 10.1097/MLR.0000000000001492.
Evidence-based health promotion programs can help older adults manage chronic conditions and address behavioral risk factors, and translating these interventions to population-scale impact depends on reaching people outside of clinical settings. Area Agencies on Aging (AAAs) have emerged as important delivery sites for health promotion programs, but the impacts of their expanded role in delivering these interventions remain unknown.
The objective of this study was to test whether evidence-based health promotion programs implemented by AAAs from 2008 to 2016 influenced health care use and spending by older adults and to examine how agencies' organizational capacity for implementation influenced these population-level impacts.
We used panel regression models to examine how the expansion of health promotion programs offered by AAAs over the course of 2008-2016 was associated with a change in health care use and spending by older adults in counties served by the AAAs. We examined impact separately for high capacity and low capacity agencies.
Across the full sample of AAAs, beginning to offer any health promotion program in the AAA was associated a with 0.94% percentage point reduction in potentially avoidable nursing home use in counties covered by the AAA (95% confidence interval=-1.58, -0.29), equivalent to a 6.5% change. Expanding the breadth of programs offered by the AAA was also associated with a significant reduction in potentially avoidable nursing home use. Stratified analysis showed that reductions in potentially avoidable nursing home use were evident only in places where the AAA had high implementation capacity. Expansion of health promotion programs offered by AAAs was not associated with the change in county-level hospital readmission rates, ambulatory care sensitive hospitalizations, or Medicare spending per beneficiary.
AAAs are an example of community-based organizations that can contribute to health care policy goals such as cost containment. Organizational development support may be needed to extend their ability to effect change in more regions of the country.
循证健康促进计划可以帮助老年人管理慢性病并解决行为风险因素，而将这些干预措施推广到人群规模的影响取决于能否接触到临床环境之外的人群。地区老龄化机构（AAA）已经成为健康促进计划的重要提供场所，但它们在提供这些干预措施方面扩大作用的影响尚不清楚。
本研究旨在检验 2008 年至 2016 年期间由 AAA 实施的循证健康促进计划是否会影响老年人的医疗保健使用和支出，并探讨机构实施的组织能力如何影响这些人群层面的影响。
我们使用面板回归模型来检验 2008-2016 年期间 AAA 提供的健康促进计划的扩展与接受 AAA 服务的县老年人的医疗保健使用和支出变化之间的关系。我们分别检验了高能力和低能力机构的影响。
在整个 AAA 样本中，开始在 AAA 提供任何健康促进计划都与覆盖 AAA 的县的疗养院潜在可避免使用减少 0.94%（95%置信区间=-1.58，-0.29）相关，相当于 6.5%的变化。扩大 AAA 提供的计划广度也与潜在可避免的疗养院使用显著减少相关。分层分析表明，只有在 AAA 具有高实施能力的地方，疗养院潜在可避免使用的减少才是明显的。AAA 提供的健康促进计划的扩展与县一级医院再入院率、门诊护理敏感住院率或每位受益人的医疗保险支出的变化无关。
AAA 是一种可以为成本控制等医疗保健政策目标做出贡献的社区组织的例子。可能需要组织发展支持来扩大它们在全国更多地区产生影响的能力。
