People with disabilities experience a staggering incidence of secondary conditions that can result in death or negatively impact their health, participation in the community, and quality of life. Many of these chronic secondary conditions are preventable. The Institute for Healthcare Improvement has advocated for optimizing care through programs that simultaneously improve health and the patient experience of care, while reducing cost, called the "Triple Aim." Studies have shown that the Triple Aim can be achieved through programs that facilitate community integration; however the U.S. healthcare system lacks a paradigm of care for individuals with disabilities that promotes community integration. In order to identify potential models of healthcare delivery for individuals with disabilities that are effective in achieving the Triple Aim, we will conduct a rigorous research project to evaluate the impact of two different models of care on the Triple Aim: 1) a community-based care management program delivered by a non-profit organization through waiver funds, and 2) the Program for All-inclusive Care for the Elderly (PACE) applied to younger individuals with disabilities between ages 55-64.
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Change in Health Outcomes: function, measured by CHART-SF.
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Change in Health Outcomes: mood, measured by PHQ9.
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Change in Health Outcomes: quality of life, measured by WHOQOL-BREF
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Change in Health Outcomes: self rating of health, measured by a likert-type scale of self rating of health.
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Change in Health Outcomes: community integration, measured by Social Capital from CQL-POMS.
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Change in Experience of Care Outcome as measured by PACIC
Timeframe: At baseline, and approximately every 3-6 months up to 24 months
Cost: Program Cost
Timeframe: Accumulation of costs and Utilization throughout the duration of participation, measured at the end of the study, up to 24 months since enrollment.
Cost: Total Medical Cost assessed by the medical and pharmacy costs.
Timeframe: Accumulation of costs and Utilization throughout the duration of participation, measured at the end of the study, up to 24 months since enrollment.
Health Care Service Utilization
Timeframe: Accumulation of costs and Utilization throughout the duration of participation, measured at the end of the study, up to 24 months since enrollment.