TY - JOUR
T1 - Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function
AU - Spoelstra, Sandra L.
AU - Sikorskii, Alla
AU - Gitlin, Laura N.
AU - Schueller, Monica
AU - Kline, Margaret
AU - Szanton, Sarah L.
N1 - Publisher Copyright:
© 2018 The American Geriatrics Society
PY - 2019/2
Y1 - 2019/2
N2 - BACKGROUND/OBJECTIVES: Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction. DESIGN: A 3-year participatory, single-group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study. SETTING: Four Medicaid home and community-based waiver sites in Michigan. PARTICIPANTS: The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older. INTERVENTION: Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies. MEASUREMENT: Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE. RESULTS: Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P =.01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P <.01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P <.01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P =.03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P <.01) and hospitalizations (0.47 ± 2.66; P <.01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community. CONCLUSION: Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363–370, 2019.
AB - BACKGROUND/OBJECTIVES: Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction. DESIGN: A 3-year participatory, single-group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study. SETTING: Four Medicaid home and community-based waiver sites in Michigan. PARTICIPANTS: The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older. INTERVENTION: Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies. MEASUREMENT: Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE. RESULTS: Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P =.01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P <.01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P <.01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P =.03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P <.01) and hospitalizations (0.47 ± 2.66; P <.01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community. CONCLUSION: Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363–370, 2019.
KW - Medicaid waiver
KW - adaptation
KW - evidence-based model
KW - implementation
KW - physical function
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U2 - 10.1111/jgs.15713
DO - 10.1111/jgs.15713
M3 - Article
C2 - 30548594
AN - SCOPUS:85058439495
SN - 0002-8614
VL - 67
SP - 363
EP - 370
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 2
ER -