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Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function
Author(s) -
Spoelstra Sandra L.,
Sikorskii Alla,
Gitlin Laura N.,
Schueller Monica,
Kline Margaret,
Szanton Sarah L.
Publication year - 2019
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15713
Subject(s) - medicine , medicaid , activities of daily living , cohort , waiver , gerontology , emergency department , physical therapy , health care , psychiatry , political science , law , economics , economic growth
BACKGROUND/OBJECTIVES Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improving physical function and examined health and use outcomes and satisfaction. DESIGN A 3‐year participatory, single‐group pretrial/posttrial benchmarked to a usual care cohort that was evaluated prior to the study. SETTING Four Medicaid home and community‐based waiver sites in Michigan. PARTICIPANTS The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older. INTERVENTION Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence‐based model of care that improved physical function in older adults, was implemented using evidence‐based strategies. MEASUREMENT Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emergency department and hospitalization visits preintervention/postintervention and in the usual care cohort were examined. We also measured Medicaid beneficiary's satisfaction with care for those who received CAPABLE. RESULTS Improved mean ± SD ADLs (preintervention, 8.51 ± 3.08; postintervention, 7.80 ± 2.86; P = .01) and IADLs (preintervention, 6.43 ± 1.31; postintervention, 5.62 ± 1.09; P < .01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P < .01), and fewer hospitalizations (from 0.43 ± 1.51 preintervention to 0.23 ± 0.60 postintervention; P = .03) were found. Post‐CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 ± 1.27; P < .01) and hospitalizations (0.47 ± 2.66; P < .01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community. CONCLUSION Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPABLE. CAPABLE may be one solution to helping vulnerable, low‐income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363–370, 2019.