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Insights for Partnerships between Community-based Organizations and Healthcare Delivery Systems: Perspective from an Evaluation of the Western Pennsylvania Community-based Care Transitions Program

Lucente-Prokop, Angela (2021) Insights for Partnerships between Community-based Organizations and Healthcare Delivery Systems: Perspective from an Evaluation of the Western Pennsylvania Community-based Care Transitions Program. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Improving transitions of care and reducing avoidable readmissions continues to be important in improving quality, safety, and overall costs of care. These goals are relevant as Pennsylvania implements Community HealthChoices, a Managed Long-Term Services and Supports program. Pennsylvania was the 24th state to implement a MLTSS model nationally. This paper summarizes the local and national context for coordinating care, while highlighting some of the pressing issues of the current environment including an aging population, increased caregiver demand and burden, challenges related to social determinants of health and the importance of care coordination and transitional care. The context and challenges summarized have public health significance locally and nationally.
A literature review highlights the distinctions between transitional care and care coordination, the public health significance of hospital readmissions, challenges during transitions of care, practices with mixed or unfavorable results, and a summary of evidence-based interventions. We conducted a mixed methods evaluation of a Community-based Care Transitions Program in Western Pennsylvania using the Care Transitions Intervention. The collaboration was part of a Medicare demonstration known as the Community-based Care Transitions Program that funded 101 communities nationally. The Western Pennsylvania community included Area Agencies on Aging as the community-based organizations and six acute care hospitals in a predominantly rural region serving Medicare beneficiaries at highest risk of readmission.
Multiple linear regression analysis was used to explore the extent to which dose of the care transitions intervention influenced outcome patient activation as measured by the Patient Activation Assessment and the Patient Activation Measure while accounting for baseline activation, hospital, age and gender. Intervention dose was significantly associated with increase in PAM, F(9,1732) =157.62, p<.0001, adjusted R2 = .447 and with increase in PAA, F(9,1337)=88.82, p<.0001, adjusted R2=.315. A cost effectiveness analysis estimated a savings of $3,926 per readmission avoided. and a finding of overall cost effectiveness of the program assuming intervention costs are below $600 and a 5% absolute reduction in readmissions. While this does not establish causality nor prove cost effectiveness, these are promising findings for additional research and translation to other communities seeking similar results.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Lucente-Prokop, AngelaAFL15@pitt.eduAFL15@pitt.edu
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairAlbert, Stevensmalbert@pitt.edusmalbert@pitt.edu
Committee MemberBear, Toddtobst2@pitt.edutobst2@pitt.edu
Committee MemberDegenholtz, Howardhoward.degenholtz@pitt.eduhoward.degenholtz@pitt.edu
Committee MemberSmith, Kenkjs8@pitt.edukjs8@pitt.edu
Date: 27 January 2021
Date Type: Publication
Defense Date: 8 December 2020
Approval Date: 27 January 2021
Submission Date: 11 December 2020
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 146
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: care transitions, cost effectiveness, readmissions, patient activation, CCTP
Date Deposited: 27 Jan 2021 18:56
Last Modified: 27 Jan 2021 18:56
URI: http://d-scholarship.pitt.edu/id/eprint/40181

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