title: Urban-rural differences in the effect of a Medicare health promotion and disease self-management program on physical function and health care expenditures.
abstract: OBJECTIVE
  To evaluate the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. To determine if these outcomes vary by urban or rural residence.
  
  
  METHODS
  We analyzed data from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio. Physical function was measured by changes in self-reported dependencies in activities of daily living over the study period. Total health care expenditures were measured by aggregating expenditures from major sources (acute, postacute, and long-term care). We used ordinary least squares models to examine the effects of the intervention on both physical function and cost outcomes during the 22-month period.
  
  
  RESULTS
  The results indicated that the intervention reduced physical functional decline by 54% (p = .03) in the study sample. Stratified analyses showed that the intervention effect was much stronger in the rural sample. Mean total health care expenditures were 11% ($3,100, p = .30) lower in the intervention group. The effects of the intervention on average health care expenditures were similar among urban and rural participants.
  
  
  CONCLUSIONS
  The intervention offered a promising strategy for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future studies need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population.
authors.affiliation: Department of Preventive Medicine, State University of New York at Stony Brook, HSC, NY 11794-8338, USA. hongdao.meng@stonybrook.edu
authors.forename: Hongdao
authors.initials: H
authors.lastname: Meng
authors.forename: Brenda
authors.initials: B
authors.lastname: Wamsley
authors.forename: Diane
authors.initials: D
authors.lastname: Liebel
authors.forename: Denise
authors.initials: D
authors.lastname: Dixon
authors.forename: Gerald
authors.initials: G
authors.lastname: Eggert
authors.forename: Joan
authors.initials: J
authors.lastname: Van Nostrand
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019468:Disease Management; D005260:Female; D005102:Health Expenditures; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D006278:Medicare; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012424:Rural Population; D012648:Self Care; D014481:United States; D014505:Urban Population