Effect of a consumer-directed voucher and a disease-management-health-promotion nurse intervention on home care use.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Meng
Hongdao
H
Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA.
Friedman
Bruce
B
Wamsley
Brenda R
BR
Mukamel
Dana
D
Eggert
Gerald M
GM
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003256:Community Participation; D003365:Costs and Cost Analysis; D019468:Disease Management; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D014481:United States