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Participants in the Program of All-Inclusive Care for the Elderly (PACE) Demonstration

Developing Disease–Impairment–Disability Profiles

^a Palmetto Richland Memorial Hospital, Division of Geriatrics Services, and Professor, Division of Geriatric Medicine, University of South Carolina School of Medicine, Columbia, SC
^b Center for Demographic Studies, Duke University, Durham, NC
^c Medfocus, Inc., Des Plains, IL
^d University of South Carolina Schools of Public Health, Columbia, SC
^e University of South Carolina Schools of Medicine, Columbia, SC
^f Palmetto Senior Care, Palmetto Richland Memorial Hospital, Columbia, SC

Correspondence: Darryl Wieland, PhD, MPH, Research Director, Palmetto Richland Memorial Hospital, Division of Geriatrics Services, and Professor, Division of Geriatric Medicine, University of South Carolina School of Medicine, 9 Medical Park, #630, Columbia, SC 29203. E-mail: isbjorn{at}aol.com.

Decision Editor: Vernon L. Greene, PhD

The Program of All-Inclusive Care for the Elderly (PACE) builds on On Lok's community-based care and financing model for disabled elderly people who are state certified as eligible for nursing home care. Yet PACE's diverse population has not been fully described. We obtained data for a complete cross-section of PACE participants from early 1997 (). Using grade-of-membership analysis, we classified participants on the basis of their specific diseases, impairments, and disabilities. The classification was reviewed by a physician panel to produce clinical profiles, which were then validated against participants' PACE tenure, demographics, supports, and health. Cognitive impairment, incontinence, and activities of daily living disabilities were influential in producing eight types, which correspond predictably to responses in tenure (the more disabled, ill types likely to be in PACE longer), demographics, health, and informal support.

Key Words: Community long-term care • Frail elderly people • Case-mix classification • Grade-of-membership analysis

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