Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function

Abstract

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.

Testing an implementation strategy bundle on adoption and sustainability of evidence to optimize physical function in community-dwelling disabled and older adults in a Medicaid waiver: a multi-site pragmatic hybrid type III protocol

“…Evidence was created and efficacy established by others [7][8][9][10]. In prior work, the evidence-based intervention was selected, barriers to implementation were identified, and the intervention was adapted to the setting and population [6]. This study will evaluate adoption and sustainability of the intervention and beneficiary outcomes.…”

“…RNs target underlying issues that influence ADLs and IADLs, such as pain reduction, improvement in mood, fall prevention, incontinence management, and medication review and management with the help of a pharmacist. In prior work, the intervention was adapted [6] to fit the waiver setting and population: SWs were added to address social and emotional needs; the number, type, and timing of clinician visits were tailored to the beneficiary's need; RNs were trained in medication management; and training and documentation modes were modified to fit the setting.…”

“…Interventions that optimize physical function to support aging-in-place are needed, particularly in settings that care for disabled and older adults. We propose to address this urgent need through the testing of an implementation strategy bundle on adoption and sustainability of an adapted intervention [6] that improves adults' ability to conduct daily tasks [7][8][9][10]. The implementation strategy bundle includes relationship, coalition, and team building; readiness to implement, leadership, and clinician attitude toward evidence assessments; intervention and facilitation training; interdisciplinary coordination; internal and external facilitation (IF, EF); and audit and feedback.…”

Addressing the Need for New Models of Care for Older Adults Receiving Long-term Dialysis

“… 17 , 18 Dissemination of the CAPABLE program has been shown to be associated with improved function, reduced falls, and fewer hospitalizations in pre-/posttrial analyses. 19 …”

Associations Between Age, Menopausal Status, and Physical Function in Middle-Aged Women

“…Physical function is a significant determinant of their ability to "age in place", or to continue to live independently despite health issues often associated with advancing age (7). Previous studies in older adults show that age, physical activity, and body composition are associated with physical function performance (8,9).…”