Patient satisfaction, empowerment, and health and disability status effects of a disease management-health promotion nurse intervention among Medicare beneficiaries with disabilities.
OBJECTIVE
To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care-affiliated disease self-management-health promotion nurse intervention for Medicare beneficiaries with disabilities and recent significant health services use.


METHODS
The Medicare Primary and Consumer-Directed Care Demonstration was a 24-month randomized controlled trial that included a nurse intervention. The present study (N = 766) compares the nurse (n = 382) and control (n = 384) groups. Generalized linear models for repeated measures, linear regression, and ordered logit regression were used.


RESULTS
The patients whose activities of daily living (ADL) were reported by the same respondent at baseline and 22 months following baseline had significantly fewer dependencies at 22 months than did the control group (p = .038). This constituted the vast majority of respondents. In addition, patient satisfaction significantly improved for 6 of 7 domains, whereas caregiver satisfaction improved for 2 of 8 domains. However, the intervention had no effect on empowerment, self-rated health, the SF-36 physical and mental health summary scores, and the number of dependencies in instrumental ADL.


CONCLUSIONS
If confirmed in other studies, this intervention holds the potential to reduce the rate of functional decline and improve satisfaction for Medicare beneficiaries with ADL dependence.
Friedman
Bruce
B
Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA. bruce_friedman@urmc.rochester.edu
Wamsley
Brenda R
BR
Liebel
Dianne V
DV
Saad
Zabedah B
ZB
Eggert
Gerald M
GM
D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D019468:Disease Management; D005260:Female; D006293:Health Promotion; D006304:Health Status; D006801:Humans; D007389:Internal-External Control; D008297:Male; D006278:Medicare; D008875:Middle Aged; D024802:Nurse's Role; D017060:Patient Satisfaction; D011209:Power, Psychological; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D014481:United States