Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Chatterji, P., Bustein, N. R., Kidder, D., & White, A. (1998, July). Evaluation of the Program of All-Inclusive Care for the Elderly (PACE) demonstration: The impact of PACE on participant outcomes. Final Report to the Health Care Financing Administration. Cambridge, MA: Abt Associates, Inc. Study 2Wieland, D., Lamb, V. L., Sutton, S. R., Boland, R., Clark, M., Friedman, S., et al. (2000). Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): Rates, concomitants, and predictors. Journal of the American Geriatrics Society, 48, 1373-1380. 
Williamson, J. D. (2000). Improving care management and health outcomes for frail older people: Implications of the PACE model. Journal of the American Geriatrics Society, 48(11), 1529-1530. Study 3Massachusetts Division of Health Care Finance and Policy. (2005). PACE evaluation summary. Unpublished manuscript. Study 4Sands, L. P., Wang, Y., McCabe, G. P., Jennings, K., Eng, C., & Covinsky, K. E. (2006). Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs. Journal of the American Geriatrics Society, 54(2), 339-344.
Supplementary Materials Greenwood, R. (2001). The PACE model. Center for Medicare Education Issue Brief, 2(10), 1-7.
National PACE Association. (2001). State assessment of PACE: Tennessee. Alexandria, VA: Author.
National PACE Association. (2001). State assessment of PACE: Texas. Alexandria, VA: Author.
National PACE Association. (2003). Core resource set for PACE. Considerations for monitoring quality assurance across PACE centers. Alexandria, VA: Author.
National PACE Association: How NPA Supports Its Members
PACE Expansion Initiative: Final Progress Report to the Robert Wood Johnson Foundation, January 1, 2001-July 30, 2004
PACE Quality: Overview of Assessments and Findings
Outcomes
| Outcome 1: Utilization of medical services |
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Description of Measures
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Utilization of medical services was analyzed using the following measures:
- Hospital utilization: any inpatient hospital admission, number of inpatient hospital days, and length of stay
- Nursing home utilization: any nursing home admission and number of nights spent in a nursing home
- Utilization of ambulatory services: any ambulatory care visits (i.e., visits with doctors, therapists, or other medical professionals) and number of ambulatory visits
- Emergency department utilization: total emergency department visits
- Acute admission: an acute illness that prevented the patient from remaining at home and would have required a hospital admission
Data for these measures were from the Abt Associates, Inc., survey of PACE participants and program sites; DataPACE, a comprehensive data collection system containing data from PACE programs; and the Massachusetts Division of Health Care Finance and Policy.
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Key Findings
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In several studies, PACE participants were compared to various other groups: older adults who expressed interest in PACE but decided not to enroll, individuals receiving Medicare due to age or disability, nursing home residents, and older adults who were eligible for nursing home care but were receiving care at home. PACE participants had significantly lower rates of hospital, nursing home, and emergency department utilization and lower overall rates of inpatient days than participants in the comparison groups (p = .01-.10). Meanwhile, PACE enrollees had higher utilization of ambulatory services than comparison group members. The size of the impact of PACE on these results decreased over time.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3, Study 4
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Study Designs
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Quasi-experimental, Preexperimental
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Quality of Research Rating
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2.4
(0.0-4.0 scale)
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| Outcome 2: Utilization of support services |
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Description of Measures
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Utilization of support services was analyzed using the following measures:
- Utilization of an adult day center: any attendance of an adult day center and frequency of attendance of an adult day center (times per week)
- Utilization of home nurses: any home visits from a nurse and number of visits from a nurse in the past 6 months
- Receipt of formal care: receipt of any formal (paid) care and receipt of formal care at least five times per week
Data for these measures were from the Abt Associates, Inc., survey of PACE participants and sites.
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Key Findings
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PACE participants were far more likely to attend adult day centers and less likely to need any home visits by a nurse than comparison group members (individuals who expressed an interest in PACE but decided not to enroll) (p < .05). Meanwhile, the likelihood and intensity of formal care services were higher in the comparison group than among PACE participants, but the difference was not statistically significant.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.5
(0.0-4.0 scale)
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| Outcome 3: Perceived health status, functional status, and overall quality of life |
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Description of Measures
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To measure the impact of PACE on perceived health status and overall quality of life, participants (or their proxy respondent) were asked questions to determine, for example, whether the participant was in good or excellent health; whether the participant's life was satisfying; and whether the participant attended social, religious, or recreational programs at least once a week. For functional status, participants (or their proxy respondent) were asked about their activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations (e.g., whether the participant had a behavioral problem, the number of ADL limitations, the number of IADL limitations, and whether the participant used an assistive device).
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Key Findings
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PACE participants reported better health status and quality of life and less deterioration in physical function than comparison group members (individuals who expressed an interest in PACE but decided not to enroll) (p = .01-.10). These effects were most dramatic during the first 6 months of enrollment in PACE.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.5
(0.0-4.0 scale)
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| Outcome 4: Mortality rate |
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Description of Measures
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To measure the impact of PACE on mortality, data from Medicare enrollment records were used. The observation period for the analysis sample ranged from 11 days to 2.5 years.
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Key Findings
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Over the course of the observation period, 19% of PACE enrollees died, compared with 25% of comparison group members (individuals who expressed an interest in PACE but decided not to enroll) (p = .03).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.5
(0.0-4.0 scale)
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| Outcome 5: Comorbidity diagnoses |
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Description of Measures
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Comorbidity diagnoses were measured using the average number of diagnoses per discharge. The data were from the Massachusetts Division of Health Care Finance and Policy.
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Key Findings
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One study compared PACE participants to two other groups: a waiver group consisting of people eligible for nursing home care but receiving care at home and a group of nursing home residents. Overall, the PACE group and waiver group had slightly fewer diagnoses per discharge (8.41 and 8.49, respectively) than the nursing home group (9.09).
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Studies Measuring Outcome
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Study 3
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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55+ (Older adult)
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69% Female
31% Male
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46% Race/ethnicity unspecified
33% Black or African American
21% Hispanic or Latino
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Study 2
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55+ (Older adult)
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71% Female
29% Male
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Data not reported/available
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Study 3
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55+ (Older adult)
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Data not reported/available
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Data not reported/available
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Study 4
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55+ (Older adult)
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70% Female
30% Male
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51% White
20% Black or African American
17% Asian
10% Hispanic or Latino
2% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Utilization of medical services
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2.5
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2.5
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2.0
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2.0
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2.0
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3.4
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2.4
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2: Utilization of support services
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2.5
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2.5
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2.0
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2.5
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2.0
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3.5
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2.5
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3: Perceived health status, functional status, and overall quality of life
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2.5
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2.5
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2.0
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2.5
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2.0
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3.5
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2.5
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4: Mortality rate
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2.5
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2.5
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2.0
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2.5
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2.0
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3.5
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2.5
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5: Comorbidity diagnoses
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2.5
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2.5
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2.0
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1.5
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2.0
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3.5
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2.3
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Study Strengths A training manual that defined measures and training procedures was used to ensure adequate psychometric properties. The program showed basic fidelity and national program support for implementation. Analyses were thoughtful, appropriate, and well done.
Study Weaknesses The methods of gathering information left questions about the data's accuracy. The comparison groups, when present, were convenience controls and limit inferences of causation to the outcomes. Attrition and missing data were often not addressed fully.
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Greenwood, R. (2001). The PACE model. Center for Medicare Education Issue Brief, 2(10), 1-7.
National PACE Association. (2002). Business planning checklist for new PACE programs. Alexandria, VA: Author.
National PACE Association. (2003). Core resource set for PACE. Considerations for monitoring quality assurance across PACE centers. Alexandria, VA: Author.
National PACE Association. (2006). PACE medical director's handbook. Alexandria, VA: Author.
National PACE Association. (n.d.). A guide to preparing the PACE provider application. Alexandria, VA: Author.
PACE Web site, http://www.npaonline.org
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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4.0
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4.0
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4.0
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4.0
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Dissemination Strengths The program materials include a comprehensive set of core resources providing guidance for starting, administering, and operating the PACE program. Program materials also include tips for partnering with State and Federal governments. High quality training and support resources are available online and through membership with the National PACE Association. Protocols for standardized implementation and oversight by the medical director are provided to support quality assurance.
Dissemination Weaknesses Most of the detailed guidance documents are available only to members of the National PACE Association. Given the complexity of this model, it would be necessary to join this association in order to benefit from its work and that of its other members.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Exploring PACE membership
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$2,880 per organization
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Yes (one membership option is required)
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Prospective provider membership
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$10,500 per organization
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Yes (one membership option is required)
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Provider membership
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$15,000 plus additional fees based on site revenue
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Yes (one membership option is required)
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Training, technical assistance/consultation, and quality assurance materials
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Contact the developer
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Contact the developer
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Additional Information PACE programs receive Medicare and Medicaid dollars to support the costs of services; in 2006, the Medicare and Medicaid capitation rate averages (per member, per month) were $1,981.16 and $2,968.76, respectively.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
* Wieland, D., Lamb, V. L., Sutton, S. R., Boland, R., Clark, M., Friedman, S., et al. (2000). Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): Rates, concomitants, and predictors. Journal of the American Geriatrics Society, 48, 1373-1380.
* Williamson, J. D. (2000). Improving care management and health outcomes for frail older people: Implications of the PACE model. Journal of the American Geriatrics Society, 48(11), 1529-1530.
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