COMPARING HOME- AND COMMUNITY-BASED CARE MODELS FOR MEDICARE/MEDICAID DUAL ELIGIBLE INDIVIDUALS JANET H. VAN CLEAVE JANETVC ) BRIAN EGLESTON, SARAH BROSCH, ELIZABETH WIRTH, MOLLY LAWSON, EILEEN SULLIVAN-MARX, MARY D. NAYLOR

STUDY AIMS Compare providers’ time and cost at 1-, 3-, and 6-months after enrollment in HCBS Compare enrollees’ health care utilization at 1-, 3-, and 6-months after enrollment in HCBS Exploratory Aim of Health Related Quality of Life: Elders in Long Term Care Study (R01AG025524; PI: M. Naylor)

METHODS & ANALYSIS Generalized linear models (GLM) Generalized estimating equations Estimated relative ratios Controlled for age, race, ethnicity, function, and comorbidity Calculated cost of care = Hours of care x hourly salaries using United States Bureau of Labor 2012 Wage Data Study population from two capitated programs: Integrated Care with Senior Day Center (N= 18, 37%) Coordinated Care (N=31, 63%) Medical record chart abstraction Data from 7 consecutive days at 1-, 3-, and 6-months after HCBS enrollment

ASSUMPTIONS DURING DATA ABSTRACTION TypeTime (minutes) Caregiver time at center90 Home or center appointment60 Follow-up visit30 Telephone call5

DEMOGRAPHIC CHARACTERISTICS (N=49) Mean age 79 Majority were women Integrated Care 89% Black No Hispanics More Education ( years) Coordinated Care 39% White, 35% Black 58% Hispanic Less Education (9+3.5 years)

CARE TIME BY PROVIDER AND SITE Provider TypeIntegrated Care [n=18] Mean Hours Per Patient Coordinated Care [n=31] Mean Hours Per Patient All Providers Home Health Aide 419 NP.29<.01 RN Case Manager Physician Social Worker Physical Therapist.01.15

GENERALIZED LINEAR MODEL: PERSONNEL COSTS ($)* VariableRelative Ratio (SE)95% CI Integrated Care Reference Coordinated Care 3.4 (.66)2.29 – 5.11*** *Controlling for age, education, race, ethnicity, gender, function, comorbidity ***P=.000

HEALTH CARE UTILIZATION* ServicesIntegrated CareCoordinated Care Hospitalizations13 Short Term Stay10 Respite Care10 *During 21-day study period

CONCLUSIONS & RECOMMENDATIONS Combining data from multiple agencies for quality of care projects is feasible Important to work with health care agency personnel during study design, data collection, and analysis of findings Integrated Care with inter-professional team and senior care centers may provide more efficient care Larger clinical effectiveness studies are needed to advance our knowledge about which HCBS care models meet this vulnerable population’s needs and desires while delivering quality care.

FUNDING Health Related Quality of Life: Elders in Long Term Care, R01AG025524, National Institute on Aging and National Institute of Nursing Research (PI: M. Naylor) Individualized Care for At-Risk Older Adults, T32NR009356, National Institute of Nursing Research. Postdoctoral Research Fellowship (PD: M. Naylor) Comparing Home- and Community-Based Long Term Care Programs: A Feasibility Study. NYU University Research Challenge Fund (PI: J. Van Cleave)