Predictors of Use of Chronic Care Services by Impaired Members in the Social Health Maintenance Organization Demonstration

Abstract

Use of chronic care services by 1,868 impaired members of the first Social Health Maintenance Organization (SHMO) demonstration was examined using a modified Andersen behavioral model. Services studied included skilled and intermediate nursing facilities, adult day care, home health, and personal care. A two-part regression analysis was performed to identify significant predictors of any use and amount of use. Individual needs such as activities of daily living were important predictors of service use even for impaired SHMO members. Variance predicted by enabling variables, especially site, was also particularly significant. This emphasizes the importance of including health plan and market factors in future modeling of service use. Other important findings were that low-income members were more likely to be placed in nursing homes and only about 65% of impaired members received any formal home care.