Meng and colleagues evaluated the impact of a multicomponent health promotion and disease self-management intervention on physical function and health care expenditures among Medicare beneficiaries. More specifically, they wished to determine if these outcomes vary by urban or rural residence. Data were analyzed from a 22-month randomized controlled trial of a health promotion/disease self-management program that included 766 elderly Medicare beneficiaries from western New York, West Virginia, and Ohio. Physical function was measured by changes in self-reported dependencies in activities of daily living over the study period. Total health care expenditures were measured by aggregating expenditures from major sources (acute, post-acute, and long-term care). Ordinary least squares models were used to examine the effects of the intervention on both physical function and cost outcomes during the 22-month period. The results indicated that the intervention reduced physical functional decline by 54% (p = .03) in the study sample. Stratified analyses showed that the intervention effect was much stronger in the rural sample. Mean total health care expenditures were 11% ($3,100, p = .30) lower in the intervention group. The effects of the intervention on average health care expenditures were similar among urban and rural participants.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that the intervention offered a promising strategy for reducing decline in physical function and potentially lowering total health care expenditures for high-risk Medicare beneficiaries, especially for those in rural areas. Future studies, they continued, need to investigate whether the findings can be replicated in other types of rural areas through a refined intervention and better targeting of the study population.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Acquiring and performing self-management skills can make a major dent in health care costs. As Congress and the President grapple with ways to improve health care for all citizens of the U.S., it is time to push all Americans to learn and perform self-management skills. This is particularly true for older and chronically ill Americans. If you are older, don’t hesitate to ask your health care provider to enroll you in a program that teaches you self-management skills. Your later competency at performing these skills will likely result in a marked improvement in your health and the quality of life you experience.

H Meng et al. Urban-Rural Differences in the Effect of a Medicare Health Promotion and Disease Self-Management Program on Physical Function and Health Care Expenditures. Gerontologist, 2009;49:407-417.