RESUMEN
Contracting with health care entities offers an avenue for Area Agencies on Aging (AAAs) to be reimbursed for providing services that improve health and avoid the need for expensive health care among older adults. However, we have little systematic evidence about the organizational characteristics and policy environments that facilitate these contractual relationships. Using survey data on AAAs from 2017-18, we found that contracting with health insurers was significantly more likely if AAAs had strong business capabilities and access to a state CBO contracting network. AAA contracting with health care delivery organizations trended with different factors, becoming more likely if states had implemented more integrated health care delivery programs, and becoming less likely if states had managed long-term services and supports. Contracting could be facilitated by supports for AAA business capabilities, as well as state policies that increase demand for their services among health insurers and health care delivery organizations.
Asunto(s)
Servicios Contratados , Atención a la Salud , Anciano , Envejecimiento , Humanos , Programas Controlados de Atención en Salud , Estados UnidosRESUMEN
BACKGROUND: Evidence-based health promotion programs can help older adults manage chronic conditions and address behavioral risk factors, and translating these interventions to population-scale impact depends on reaching people outside of clinical settings. Area Agencies on Aging (AAAs) have emerged as important delivery sites for health promotion programs, but the impacts of their expanded role in delivering these interventions remain unknown. OBJECTIVE: The objective of this study was to test whether evidence-based health promotion programs implemented by AAAs from 2008 to 2016 influenced health care use and spending by older adults and to examine how agencies' organizational capacity for implementation influenced these population-level impacts. RESEARCH DESIGN: We used panel regression models to examine how the expansion of health promotion programs offered by AAAs over the course of 2008-2016 was associated with a change in health care use and spending by older adults in counties served by the AAAs. We examined impact separately for high capacity and low capacity agencies. RESULTS: Across the full sample of AAAs, beginning to offer any health promotion program in the AAA was associated a with 0.94% percentage point reduction in potentially avoidable nursing home use in counties covered by the AAA (95% confidence interval=-1.58, -0.29), equivalent to a 6.5% change. Expanding the breadth of programs offered by the AAA was also associated with a significant reduction in potentially avoidable nursing home use. Stratified analysis showed that reductions in potentially avoidable nursing home use were evident only in places where the AAA had high implementation capacity. Expansion of health promotion programs offered by AAAs was not associated with the change in county-level hospital readmission rates, ambulatory care sensitive hospitalizations, or Medicare spending per beneficiary. CONCLUSIONS: AAAs are an example of community-based organizations that can contribute to health care policy goals such as cost containment. Organizational development support may be needed to extend their ability to effect change in more regions of the country.
Asunto(s)
Redes Comunitarias/organización & administración , Conductas Relacionadas con la Salud , Educación en Salud/organización & administración , Promoción de la Salud/organización & administración , Anciano , Envejecimiento , Femenino , Humanos , Masculino , Medicare/organización & administración , Salud Poblacional , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Estados UnidosRESUMEN
Millions of older Americans depend on services provided by Area Agencies on Aging to support their nutritional, social, and health needs. Social distancing requirements and the closure of congregate activities due to COVID-19 resulted in a rapid and dramatic shift in service delivery modes. Area Agencies on Aging were able to quickly pivot due to their long-standing expertise in community needs assessment and cross-sectoral partnerships. The federal Coronavirus relief measures also infused one billion dollars into the Aging Network. As the pandemic response evolves, Area Agencies on Aging are poised to be key partners in a transformed health system.
Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Servicio Social/organización & administración , Anciano , Anciano de 80 o más Años , Envejecimiento , Betacoronavirus , COVID-19 , Creación de Capacidad/organización & administración , Servicios de Salud Comunitaria/organización & administración , Abastecimiento de Alimentos , Humanos , Relaciones Interinstitucionales , Persona de Mediana Edad , Pandemias , Derivación y Consulta/organización & administración , SARS-CoV-2 , Estados Unidos/epidemiologíaRESUMEN
Area Agencies on Aging are increasingly partnering with health care organizations to address the health-related social needs of older adults and contribute to multisector coalitions that promote community health. Using survey data for the period 2008-13, we examined the potential health impacts of establishing such partnerships. Partnerships with hospitals located in an agency's service county were associated with a reduction of $136 in average annual Medicare spending per beneficiary, while partnerships with mental health organizations in an agency's service county saw potentially avoidable nursing home use fall by 0.5 percentage points. When agencies were funded participants in livable community initiatives-multisector coalitions to promote the well-being and health of older adults-potentially avoidable nursing home use fell by nearly 1 percentage point. Our results suggest that investments in health and human services partnerships through Area Agencies on Aging can yield health returns among older adults, in the form of reduced health care use and spending.
Asunto(s)
Medicare , Servicio Social , Anciano , Envejecimiento , Atención a la Salud , Gastos en Salud , Humanos , Instituciones de Cuidados Especializados de Enfermería , Estados UnidosRESUMEN
The relationship between education and health is well-established, but theoretical pathways are not fully understood. Economic resources, stress, and health behaviors partially explain how education influences health, but further study is needed. Previous studies show that health literacy mediates the education-health relationship, as do general literacy skills. However, little is known whether such mediation effects are consistent across different societies. This study analyzed data from the International Assessment of Adult Literacy and Life Skills Survey conducted in Canada, the United States, Italy, Norway, Switzerland, and Bermuda to investigate the mediation effects of literacy on the education-health relationship and the degree of such mediation in different cultural contexts. Results showed that literacy skills mediated the effect of education on health in all study locations, but the degree of mediation varied. This mediation effect was particularly strong in Bermuda. This study also found that different types of literacy skills are more or less important in each study location. For example, numeracy skills in the United States and prose (reading) literacy skills in Italy were stronger predictors of health than were other literacy skills. These findings suggest a new direction for addressing health disparities: focusing on relevant types of literacy skills.
Asunto(s)
Alfabetización en Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Internacionalidad , Adolescente , Adulto , Anciano , Bermudas , Canadá , Escolaridad , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Noruega , Suiza , Estados Unidos , Adulto JovenRESUMEN
In response to increasing Medicaid expenditures and consumer preferences, states are reforming their long-term care systems to provide more community-based services. One popular reform is renewed efforts to prevent unnecessary long-term nursing home placement (diversion) and to provide nursing home residents an opportunity to return to the community (transition). Nearly 3,800 individuals, 60 years old and older, participated in Ohio's statewide nursing home diversion and transition initiative between March 2010 and May 2011. This research tracked outcomes for consumers and evaluated the implementation of the new program. Nearly 80% of diversion and transition participants who were still living at the time of their 6-month follow-up were residing in the community. An agency-level process analysis revealed innovative intervention strategies, promising practices, and barriers. Process results found that Area Agencies on Aging (AAAs) have become more proactive in working with high-risk individuals, with agencies identifying new at-risk consumers through hospital and nursing home interventions.
Asunto(s)
Servicios de Salud Comunitaria , Desinstitucionalización , Servicios de Atención de Salud a Domicilio , Hogares para Ancianos , Medicaid , Casas de Salud , Anciano , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/estadística & datos numéricos , Costos y Análisis de Costo , Desinstitucionalización/organización & administración , Desinstitucionalización/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hogares para Ancianos/economía , Hogares para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Masculino , Casas de Salud/economía , Casas de Salud/estadística & datos numéricos , Innovación Organizacional/economía , Desarrollo de Programa , Medición de Riesgo , Estados UnidosRESUMEN
The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education.
Asunto(s)
Competencia Clínica/normas , Escolaridad , Geriatría/educación , Internacionalidad , Evaluación de Programas y Proyectos de Salud/métodos , Curriculum , Educación de Postgrado en Medicina/normas , Evaluación del Rendimiento de Empleados , Guías como Asunto , Humanos , Proyectos de Investigación , Estados UnidosRESUMEN
Greater distance to health care facilities is associated with poorer health care service utilization, yet little is known about how the 'decay effect' of distance influences the outcome of heart disease that requires frequent medical care. Heart disease has been a leading cause of death in the United States for a last few decades, even with significant improvements in treatment and management. In this study, we examined the association between physical distance to hospitals and heart disease mortality. The geographic information system (GIS) approach was taken to integrate, visualize and analyze data from multiple sources. Hospitals in the state of Ohio were geocoded and zonal statistics were computed to quantify geographical access to hospitals at the level of Ohio's 88 counties. Whereas the results of bivariate analysis showed a significant association between distance to hospitals and heart disease mortality, this relationship was not significant when accounting for socioeconomic and socio-demographic factors. This study demonstrates the usefulness of visualized health data and makes a case for further research on associations between disease outcomes and access to health care services.
Asunto(s)
Accesibilidad a los Servicios de Salud , Cardiopatías/mortalidad , Demografía , Femenino , Sistemas de Información Geográfica , Hospitales , Humanos , Masculino , Análisis Multivariante , Ohio/epidemiología , Factores SocioeconómicosRESUMEN
This research found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This advantage remained after age, gender, socioeconomic status, loneliness, and functional health were included as covariates. It was also found that this effect is partially mediated by will to live. The sample consisted of 660 individuals aged 50 and older who participated in a community-based survey, the Ohio Longitudinal Study of Aging and Retirement (OLSAR). By matching the OLSAR to mortality data recently obtained from the National Death Index, the authors were able to conduct survival analyses. The findings suggest that the self-perceptions of stigmatized groups can influence longevity.