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Two varieties of managed long-term c...

Columbia University.

Two varieties of managed long-term care: Comparing PACE and Medicaid-only models.

紀錄類型:	書目-電子資源 : 單行本
正題名/作者:	Two varieties of managed long-term care: Comparing PACE and Medicaid-only models./
作者:	Nadash, Pamela.
面頁冊數:	148 p.
附註:	Source: Dissertation Abstracts International, Volume: 69-10, Section: B, page: 6049.
Contained By:	Dissertation Abstracts International69-10B.
標題:	Gerontology. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoeng/servlet/advanced?query=3333414
ISBN:	9780549859093

Two varieties of managed long-term care: Comparing PACE and Medicaid-only models.
Nadash, Pamela.

Two varieties of managed long-term care: Comparing PACE and Medicaid-only models. - 148 p.

Source: Dissertation Abstracts International, Volume: 69-10, Section: B, page: 6049.

Thesis (Ph.D.)--Columbia University, 2008.

The study compares populations and outcomes associated with two models of managed long term care (MLTC). Currently, little evidence exists regarding the relative merits of different ways of integrating care when serving people needing long-term services and supports. Compared were a partially capitated Medicaid-only model (MMLTC), which capitates only LTC services, and one that capitates payment for all Medicare and Medicaid services---the Program for All Inclusive Care for the Elderly (PACE). The study, which used a retrospective cohort design, looked at the following outcomes over 18 months: morbidity, discharge, change in functional status (ADLs and IADLs), hospitalization, and institutionalization for 3200 individuals. Data came from the Outcome and Assessment Information Set (OASIS) instrument and plan administrative data for the MMLTC plan and from the PACE public use national dataset for the PACE program. The study found that, although the populations enrolled in the two programs were very close in average functional status, signs pointed to a sicker and more cognitively impaired PACE population. Descriptive statistics and multivariate analyses adjusting for baseline status found much higher rates of death in the PACE program (22% vs. 10% over 18 months) as well as a greater likelihood of functional decline (in IADLs) and nursing home admission, despite similar rates of discharge. However, hospital utilization was higher for the MMLTC plan. Propensity score stratification was used to adjust these findings for selection effects; it reduced the impact of program enrollment on the outcomes under study, finding no differences between the MMLTC plan and PACE in their ability to prevent mortality, maintain functional status, and limit nursing home admission; findings with respect to hospitalization were more ambiguous. Further investigation will be warranted to determine why full capitation does not deliver superior outcomes, as would be expected.

ISBN: 9780549859093Subjects--Topical Terms:

168436
Gerontology.

Two varieties of managed long-term care: Comparing PACE and Medicaid-only models.
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