title: Outcomes of a community-based dissemination of the health enhancement program.
abstract: OBJECTIVE
  We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community-dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase.
  
  
  METHODS
  Outcome evaluation using a within-group, pretest-posttest design.
  
  
  METHODS
  Fourteen senior centers located throughout western Washington.
  
  
  METHODS
  Three hundred four community-dwelling men and women aged 65 and older.
  
  
  METHODS
  A disability-prevention, chronic disease-self-management program.
  
  
  METHODS
  Participant characteristics, risk factors for disability, change in health and functional status, and healthcare use over 1 year of enrollment; participant satisfaction.
  
  
  RESULTS
  Participants were 71% female, had a mean age of 76, and reported three chronic health conditions on average. The percentage of participants found to be depressed decreased (28% at time of enrollment vs 17% at 1-year follow-up, P =.005). The percentage of physically inactive participants decreased (56% vs 38%, P =.001). Physical activity level and exercise readiness improved (Physician-based Assessment and Counseling for Exercise mean score 4.3 vs 5.1, P =.001). At follow-up, 83% rated their health the same as or better than a year ago, compared with 73% at time of enrollment. The proportion with impaired functional status, as measured by bed days and restricted activity days, stayed the same. The proportion hospitalized remained stable (23% at enrollment and follow-up, P = 1.0).
  
  
  CONCLUSIONS
  Under real world conditions, the Health Enhancement Program reaches older people at risk of functional decline. Those enrolled for 1 year experience a reduction in disability risk factors, improvement in health status, no decrements in functional status, and no increase in self-reported healthcare use.
authors.affiliation: Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health and Community Medicine, Seatle, Washington 98104, USA. phelane@u.wahington.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Phelan
authors.forename: Barbara
authors.initials: B
authors.lastname: Williams
authors.forename: Suzanne
authors.initials: S
authors.lastname: Leveille
authors.forename: Susan
authors.initials: S
authors.lastname: Snyder
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: James P
authors.initials: JP
authors.lastname: LoGerfo
mesh_terms: D000368:Aged; D003153:Community Health Services; D003625:Data Collection; D005260:Female; D006299:Health Services for the Aged; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D012307:Risk Factors; D012648:Self Care; D014861:Washington