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Cost Effectiveness of Living Well with a Disability<\/span><\/strong><\/p>\n November, 1999<\/span><\/p>\n Interest in the prevention of secondary conditions experienced by people with disabilities has increased the demand for empirically-derived, cost-effective programs and procedures to achieve enhanced health and wellness outcomes.\u00a0 <\/span><\/p>\n Health promotion programs must be developed and evaluated for widespread adoption and implementation. Successful programs are expected to produce desirable results, be acceptable to consumers, be compatible within a delivery context, and be cost-effective.<\/span><\/p>\n Over the past several years, researchers at the RTC: Rural at The University of Montana<\/a> and the Research & Training Center on Independent Living<\/a> at the University of Kansas have collaborated on developing the Living Well with a Disability<\/a> program (Ravesloot et al., 1994; Seekins et al., 1999). This program has been designed for delivery through centers for independent living (CILs) for adults with mobility impairments. It produces desirable health outcomes, is favorably reviewed by consumers, is compatible with independent living philosophy, and is effectively delivered through CILs. This report summarizes preliminary data addressing the cost-effectiveness of Living Well with a Disability.<\/p>\n Research Goal <\/strong><\/p>\n Our goal was to assess the cost-effectiveness of a community-based model for preventing and managing secondary conditions experienced by adults with physical disabilities. To accomplish this, we established several objectives:<\/p>\n Disseminate successful methods and materials to public health agencies, managed care providers, and community-based disability service programs.<\/span><\/p>\n Key Terms and Concepts<\/strong><\/span> Cost-effectiveness analysis<\/span><\/strong><\/span> is a methodology to assess the comparative impacts of expenditures on alternative health interventions (Gold et al., 1996).<\/span><\/p>\n Health<\/strong> <\/span> refers to the status of multiple factors, both internal and external, not simply physiological status. Underlying the Living Well program is the belief that health is not an end in itself but a means to an end.<\/p>\n Center for Independent Living<\/span><\/strong><\/span> is a community-based, non-profit, consumer-directed, non-residential organization designed to both advocate for and provide support services to people with disabilities to help them live independently in their communities.<\/p>\n Living Well with a Disability<\/a><\/span> is a wellness program focused on helping adults with disabilities manage secondary conditions that limit their participation in daily life. Individuals follow a copyrighted text to develop health behaviors for reducing secondary conditions.<\/p>\n Methods <\/strong><\/span><\/p>\n The Living Well with a Disability program is an eight-week course taught by trained facilitators to groups of 8 – 12 adults with disabilities. The program begins by helping participants identify how daily health behaviors contribute to the pursuit and attainment of long-term goals. Then, using a variety of problem-solving techniques including solution generation, depression prevention, and communication, the program helps participants make progress toward goals. During this process, the participants develop healthy behaviors such as physical activity and proper nutrition as steps toward their goals.<\/p>\n This research began with a national competition among CILs in response to a request for proposal from two research institutions (The Universities of Montana and Kansas) through the Association of Programs for Rural Independent Living<\/a> and the National Council on Independent Living<\/a>. A total of 106 applications were received. A national advisory group selected nine applicants to serve as replication sites. Each site received contracts to conduct four Living Well workshops. The contracts reimbursed the CILs a total of $2,430 for each workshop conducted. Additional monies were disbursed to cover costs associated with data collection efforts.<\/p>\n Two individuals from each CIL received training in the application of the Living Well program. These individuals included either two staff members, or one staff member and one consumer leader. After training, Living Well facilitators began recruiting participants from their local communities. Potential participants were randomly assigned to one of two groups. Participation in the Living Well program was staggered in time across the two groups. The first group completed a pre-measure and immediately began the Living Well program. The second group completed two pre-measures two months apart and then began the Living Well program. Both groups completed post- test measures immediately after completing the program, and at two months, four months, and one year after participation. This staggered schedule was then replicated with two additional groups. To date, a total of 162 people with disabilities have participated in the program.<\/p>\n Measures were collected using the Secondary Conditions Surveillance Instrument. The instrument collects self-reported data on the extent of limitation due to 44 secondary conditions. It also collects data on the utilization of a variety of medical and social services. This preliminary report is based on 77 participants from the first two waves of intervention who completed pre-measures and a 4-month follow-up measure.<\/p>\n Evaluating Disability Outcome <\/strong><\/span><\/p>\n The Living Well with a Disability program reduces limitation experienced by adults with mobility impairments. Participants’ ratings of their limitation due to secondary conditions are 10.4% lower 4 months after the intervention than they were prior to it (p <.05). These results are paralleled by an 11.3% increase in health behaviors such as the participant’s tendency to take more responsibility for his or her own health outcomes (p < .05). Finally, participants reported 1.77 fewer days per month with poor mental status (p < .05). The Living Well cost estimates are based on survey data collected upon entry into the program and from the 4-month follow-up measure. The cost estimates in Table 1 were calculated by multiplying mean values for different categories of health utilization by respective Medicare “price”, or fees, based on 1997 national data for the Medicare program. Overall, the average expenditure for medical services used by participants during the two months before the Living Well program was $4,098. Four months after participating in the Living Well program, reported cost of medical services averaged $3,704. Table 1 presents the average expenditure per participant across seven medical service categories both before and after the Living Well intervention.<\/p>\n <\/a><\/strong><\/span>Average Health Resource Utilization Costs<\/strong><\/span>\n
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\nA secondary condition<\/span><\/strong> occurs when a person with a disability develops a complication related to his or her impairment (Marge, 1988). Measured in “hours of limitation per week”, the secondary condition adversely affects health and independence.<\/p>\n
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\nEstimating Cost Effectiveness <\/strong> <\/span><\/span><\/p>\n
\nDescription of Table 1<\/a><\/p>\n