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(Unpublished)
This is the latest version of this item.
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
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| Status: |
Unpublished |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Lucente-Prokop, Angela | AFL15@pitt.edu | AFL15@pitt.edu | |
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| ETD Committee: |
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| 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: |
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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Insights for Partnerships between Community-based Organizations and Healthcare Delivery Systems: Perspective from an Evaluation of the Western Pennsylvania Community-based Care Transitions Program. (deposited 27 Jan 2021 18:56)
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