title: Clinical outcomes of aging in place.
abstract: BACKGROUND
  Programs such as Medicaid Home and Community-based Services (HCBS) have provided an alternative to institutionalization through community-based, long-term care services; however, there are limited studies on the clinical outcomes of participants in these programs as compared to nursing home (NH) residents.
  
  
  OBJECTIVE
  To compare clinical outcomes of individuals in a community-based, long-term care program to individuals of similar case mix in institutional-based, long-term care.
  
  
  METHODS
  A program called Aging in Place (AIP) was developed by the Sinclair School of Nursing in cooperation with the state of Missouri's HCBS program. The AIP intervention consisted of nurse coordination of the HCBS program and Medicare home health services. A total of 78 AIP participants were matched with 78 NH residents on admission period, activities of daily living (ADLs), cognitive status, and age. The Minimum Data Set (MDS) was collected on the AIP group at admission and every 6 months over a 30-month period. Cognition was measured by the MDS Cognitive Performance Scale (CPS), ADLs by the sum of 5 MDS ADL items, depression by the MDS-Depression Rating Scale, and incontinence by rating on 2 MDS items related to urinary continence. The Cochran-Mantel-Haenszel method was used to test the association between the AIP intervention and clinical outcomes.
  
  
  RESULTS
  The AIP group clinical outcomes were better at a statistically significant level (less than .05) for the following outcomes: (a) cognition at 6, 12, and 18 months (p = .00); (b) depression at 6 and 12 months (p = .00); (c) ADL at 6 (p = .02), 12 (p = .04), and 24 (p = .00) months; and (d) incontinence at 24 (p = .02) months. In all 4 outcome measures, the AIP group stabilized or improved outcome scores whereas the NH group's outcome scores deteriorated.
  
  
  CONCLUSIONS
  Study results suggest that community-based care with nurse coordination enhances clinical outcomes of long-term care participants.
authors.affiliation: University of Wisconsin-Milwaukee, PO Box 413, WI 52301, USA. kmarek@uwm.edu
authors.forename: Karen Dorman
authors.initials: KD
authors.lastname: Marek
authors.forename: Lori
authors.initials: L
authors.lastname: Popejoy
authors.forename: Greg
authors.initials: G
authors.lastname: Petroski
authors.forename: David
authors.initials: D
authors.lastname: Mehr
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rantz
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Lin
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003071:Cognition; D003153:Community Health Services; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes