Five-year survival in a Program of All-inclusive Care for Elderly compared with alternative institutional and home- and community-based care.

Wieland, Darryl

Boland, Rebecca

Baskins, Judith

Kinosian, Bruce

United States

2017-06-08T18:26:07Z

2017-06-08T18:26:07Z

2010-07

BACKGROUND: Community-based services are preferred to institutional care for people requiring long-term care (LTC). States are increasing their Medicaid waiver programs, although Program of All-Inclusive Care For Elderly (PACE)-prepaid, community-based comprehensive care-is available in 31 states. Despite emerging alternatives, little is known about their comparative effectiveness. METHODS: For a two-county region of South Carolina, we contrast long-term survival among entrants (n = 2040) to an aged and disabled waiver program, PACE, and nursing homes (NHs), stratifying for risk. Participants were followed for 5 years or until death; those lost to follow-up or surviving less than 5 years as on August 8, 2005 were censored. Analyses included admission descriptive statistics and Kaplan-Meier curves. To address cohort risk imbalance, we employed an established mortality risk index, which showed external validity in waiver, PACE, and NH cohorts (log-rank tests = 105.42, 28.72, and 52.23, respectively, all p < .001; c-statistics = .67, .58, .65, p < .001). RESULTS: Compared with waiver (n = 1,018) and NH (n = 468) admissions, PACE participants (n = 554) were older, more cognitively impaired, and had intermediate activities of daily living dependency. PACE mortality risk (72.6% high-to-intermediate) was greater than in waiver (58.8%), and similar to NH (71.6%). Median NH survival was 2.3 years. Median PACE survival was 4.2 years versus 3.5 in waiver (unstratified, log rank = .394; p = .53), but accounting for risk, PACE's advantage is significant (log rank = 5.941 (1); p = .015). Compared with waiver, higher risk admissions to PACE were most likely to benefit (moderate: PACE median survival = 4.7 years vs waiver 3.4; high risk: 3.0 vs 2.0). CONCLUSION: Long-term outcomes of LTC alternatives warrant greater research and policy attention.

https://www.ncbi.nlm.nih.gov/pubmed/20354065

glq040

1758-535X

https://hdl.handle.net/10161/14894

eng

Oxford University Press (OUP)

J Gerontol A Biol Sci Med Sci

10.1093/gerona/glq040

Aged

Community Health Services

Comprehensive Health Care

Female

Health Services for the Aged

Homes for the Aged

Humans

Kaplan-Meier Estimate

Long-Term Care

Male

South Carolina

Survival Analysis

Five-year survival in a Program of All-inclusive Care for Elderly compared with alternative institutional and home- and community-based care.

Journal article

https://www.ncbi.nlm.nih.gov/pubmed/20354065

721

726

7

Center for Population Health & Aging

Duke

Duke Population Research Institute

Sanford School of Public Policy

Staff

Published

65