The Program of All-Inclusive Care for the Elderly (PACE) is a community-based alternative to nursing home care for frail elderly who have significant functional and/or cognitive impairments. It is a managed care program that integrates primary and long term care services with acute care. Rapid expansion of the PACE program is anticipated as a result of the Balanced Budget Act of 1997. The innovative care approach adopted by the PACE program holds the promise of higher quality care, better health outcomes and lower costs compared to care offered to frail elderly enrolled in traditional Medicare and Medicaid programs, or managed care programs. Past studies demonstrated that PACE compares favorably with Medicare fee-for-service care. They have also shown that there is significant variation in health outcomes across sites. This suggests that quality of care in PACE could be improved further. The causes for these variations, and the specific program characteristics associated with them, have not been studied to date. The objective of this study is to identify opportunities for improvements by investigating the links between programs' structure, process and risk-adjusted health outcomes. The study will include 26 PACE sites currently in operation. Individual level data about health outcomes and participants' risks at admission will be used to create risk adjusted outcome measures of quality for each site. Four outcome measures will be developed, based on mortality, changes in functional status, changes in self assessed health status and hospitalizations. These data will be linked to site level data that characterize the structure and process of care in each site. Data about structure and process will be obtained from the National PACE database and from surveys and site visits. Structure and process dimensions will include: Participant characteristics, e.g., health and functional status, ethnicity, family support; Providers' characteristics, e.g., staff turn over, specialty mix, measures of team interactions; Organizational characteristics, e.g., relationship with sponsoring organization, risk sharing, maturity of the site; and External environmental influences, e.g., area practice styles, competition. Statistical regression techniques will be used to test hypotheses about the links between structure, process and outcomes. The knowledge gained from this study would have direct bearing on efforts to improve care in PACE programs, as well as implications for other programs serving frail, non-institutionalized elderly.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG017555-03
Application #
6509700
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Stahl, Sidney M
Project Start
2000-06-01
Project End
2004-05-31
Budget Start
2002-06-01
Budget End
2003-05-31
Support Year
3
Fiscal Year
2002
Total Cost
$349,613
Indirect Cost
Name
University of Rochester
Department
Public Health & Prev Medicine
Type
Schools of Dentistry
DUNS #
208469486
City
Rochester
State
NY
Country
United States
Zip Code
14627
Temkin-Greener, Helena; Bajorska, Alina; Mukamel, Dana B (2008) Variations in service use in the Program of All-Inclusive Care for the Elderly (PACE): is more better? J Gerontol A Biol Sci Med Sci 63:731-8
Mukamel, Dana B; Temkin-Greener, Helena; Delavan, Rachel et al. (2006) Team performance and risk-adjusted health outcomes in the Program of All-Inclusive Care for the Elderly (PACE). Gerontologist 46:227-37
Friedman, Susan M; Steinwachs, Donald M; Temkin-Greener, Helena et al. (2006) Informal caregivers and the risk of nursing home admission among individuals enrolled in the program of all-inclusive care for the elderly. Gerontologist 46:456-63
Temkin-Greener, Helena; Bajorska, Alina; Mukamel, Dana B (2006) Disenrollment from an acute/long-term managed care program (PACE). Med Care 44:31-8
Friedman, Susan M; Steinwachs, Donald M; Rathouz, Paul J et al. (2005) Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people. Gerontologist 45:157-66
Temkin-Greener, Helena; Bajorska, Alina; Peterson, Derick R et al. (2004) Social support and risk-adjusted mortality in a frail older population. Med Care 42:779-88
Gross, Diane L; Temkin-Greener, Helena; Kunitz, Stephen et al. (2004) The growing pains of integrated health care for the elderly: lessons from the expansion of PACE. Milbank Q 82:257-82
Temkin-Greener, Helena; Gross, Diane; Kunitz, Stephen J et al. (2004) Measuring interdisciplinary team performance in a long-term care setting. Med Care 42:472-81
Mukamel, Dana B; Bajorska, Alina; Temkin-Greener, Helena (2002) Health care services utilization at the end of life in a managed care program integrating acute and long-term care. Med Care 40:1136-48
Temkin-Greener, Helena; Mukamel, Dana B (2002) Predicting place of death in the program of all-inclusive care for the elderly (PACE): participant versus program characteristics. J Am Geriatr Soc 50:125-35

Showing the most recent 10 out of 11 publications