The Relationship between Length of PACE Program Participation and Hospital Services Utilization

Background and Purpose

Given the complex health conditions of the growing elderly population, major concerns exist regarding unintended adverse health outcomes and healthcare costs for the frail elderly. Altogether, frail older adults consume nearly 50% of the health care expenditures, with 42% hospitalized each year. They disproportionately constitute the highest percentage of consumers within the health care system. It is critical to ensure that the health services delivery system employs appropriate treatment protocols which prevent unintended adverse health outcomes while at the same time addressing concerns regarding healthcare costs that do not yield benefits for this fast-growing population. The Program of All-inclusive Care for the Elderly (PACE) uses an interdisciplinary approach to provide appropriate treatment protocol to manage utilization among frail older adults who are eligible for Medicaid and Medicare. This research sought to determine the relationship between length of program participation and hospital services utilization among PACE participants. Did length of program participation reduce hospital and emergency department (ED) use among enrollees of a PACE program in West Michigan?

Methods

A retrospective study design was used on a convenient sample (N = 109) of PACE participants who had used hospital and ED services from March through December of 2015. The study compared two groups based on the length of program participation. Length of program participation was measured in months from January 2009 through December 2015 and transformed into two dichotomous categorical variables: “equal or fewer than 18 months” and “more than 18 months”. The 18-month cutoff was informed by the Stages of Change model. The study used poisson regression analysis to compare the likelihood of using hospital and ED services between the two groups.

Results

Participants with less or equal to 18 months of program participation had 43.9% (95%, CI = 1.686, 2.038, p = .04), increased risk of visiting the ED compared to those who had more than 18 months of program participation. For each additional year of program participants, enrollees had a 2.2% decreased risk of visiting the ED (95%, CI = .978, 994, p < .01). Hospital admissions did not show any statistically significant difference between the two groups.

Conclusions and Implications

The results would suggest significant change in healthcare seeking behaviors related to ED visits among those who had participated in the program longer than 18 months. The change fits the Stages of Change model timeline, showing ED use behavior changes after 18 months of program participation. Results confirm the importance of education aimed at healthcare seeking behaviors changes among frail older adults among service providers. The use of PACE as a primary provider among older adults reduce unnecessary use of the ED. In order to minimize use of health services that do not yield benefit and maximize health outcomes among older adults, PACE should be promoted among all states’ Medicaid agencies. Only 33 out of the 50 states use PACE.