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The Gerontologist 45:167-176 (2005)
© 2005 The Gerontological Society of America

Effect of a Consumer-Directed Voucher and a Disease-Management–Health-Promotion Nurse Intervention on Home Care Use

Hongdao Meng, PhD1,2, Bruce Friedman, PhD1,3, Brenda R. Wamsley, PhD4, Dana Mukamel, PhD5 and Gerald M. Eggert, PhD2

Correspondence: Address correspondence to Bruce Friedman, PhD, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Box 644, Rochester, NY 14642. E-mail: bruce_friedman{at}urmc.rochester.edu

Purpose:We describe the impact of two interventions, a consumer-directed voucher for in-home supportive services and a chronic disease self-management–health-promotion nurse intervention, on the probability of use of two types of home care—skilled home health care and personal assistance services—received by functionally impaired Medicare beneficiaries. Design and Methods: The Medicare Primary and Consumer-Directed Care Demonstration was a randomized controlled trial in 19 counties in New York, West Virginia, and Ohio with four groups: disease-management–health-promotion nurse, consumer-directed voucher, combination (nurse plus voucher), and control. We estimated a bivariate probit model for the 1,394 individuals aged 65 or older who had no private long-term-care insurance. Results: Whereas the nurse intervention alone had no effect on the probability of using either type of home care, the voucher alone increased the probability of personal assistance services use by 13% (p =.002) but not that of skilled home health care use. The combination of the two interventions increased the probability of personal assistance services use by 18% (p <.001). Implications: The implementation of disease-management–health-promotion nurse interventions should not lead to a greater probability of skilled home health care or personal assistance services use, whereas the provision of consumer-directed vouchers should result in an increased probability of personal assistance services use, as intended.

Key Words: Consumer direction • Disease management • Health promotion • Skilled home care • Personal assistance services




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