title: Evaluation of a health promotion demonstration program for the rural elderly.
abstract: OBJECTIVE
  This article evaluates a demonstration program that extended coverage for disease prevention/health promotion services to Medicare beneficiaries.
  
  
  METHODS
  Community-dwelling Medicare beneficiaries who lived in five rural counties in northwest Pennsylvania were recruited between May and December 1989. The demonstration lasted 18 months and beneficiaries were followed for an additional 18 months. Data for the evaluation came from an initial health risk assessment, Medicare administrative records, follow-up surveys, and redeemed vouchers for the waivered services. The waivered services included health screenings, influenza immunization, nutritional counseling, smoking and alcohol cessation, and depression/dementia evaluations.
  
  
  METHODS
  Medicare beneficiaries were randomized to one of two experimental groups and a control group. One experimental group received the newly waived services from hospitals that received a capitated fee; the other received services from providers who were paid fee-for-service. Eligibility for most waivered services was based on risk. Chi-square tests of association were used to determine if use of health promotion services and use of medical care services varied across groups. Logistic regressions were used to assess the factors associated with participation. Product-limit survival analysis was used to assess whether mortality rates varied across groups.
  
  
  RESULTS
  Participation rates in the new programs varied by program and by experimental group, and ranged from 16.8 percent for smoking cessation programs to 58 percent for influenza immunization. The demonstration led to an increase in influenza immunization rates relative to the control group. There were no differences in the use of medical care services or health outcomes between the experimental and control groups.
  
  
  CONCLUSIONS
  Older rural Americans will modestly increase their use of disease prevention/ health promotion services if they are covered by Medicare. Use will be higher among those with more education. Further research is needed to assess long-term benefits of such programs.
authors.affiliation: Department of Health Services Administration, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Lave
authors.forename: D G
authors.initials: DG
authors.lastname: Ives
authors.forename: N D
authors.initials: ND
authors.lastname: Traven
authors.forename: L H
authors.initials: LH
authors.lastname: Kuller
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002204:Capitation Fee; D002391:Catchment Area, Health; D014487:Centers for Medicare and Medicaid Services, U.S.; D018588:Fee-for-Service Plans; D005260:Female; D006293:Health Promotion / Q000191:economics* / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000458:organization & administration* / Q000706:statistics & numerical data; D015442:Medicare Assignment; D010414:Pennsylvania; D010865:Pilot Projects; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015397:Program Evaluation; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States