Role of Organizational Capacity in Enabling Population Health Impact for Health Promotion Programs

Abstract

Objective: To examine how organizational capacity of Area Agencies on Aging, a type of community-based social service agency, influenced their ability to achieve population-level impact through their health promotion programs. Methods: We used difference-in-difference regression models to examine how expansion of health promotion program offered by Agencies over the course of 2008-2016 was associated with change in county-level measures of health care use and spending by older adults. We examined impact separately for high capacity and low capacity agencies. Results: Offering any health promotion program was associated a with 0.94% percentage point reduction in avoidable nursing home use in counties covered by the agency (95% confidence interval = -1.58, -0.29), equivalent to a 6.5% change. Expanding breadth of program offerings was also associated with significant reduction in avoidable nursing home use. Stratified analysis showed reductions were evident only where agencies had high implementation capacity. Conclusions: Evidence-based health promotion programs offered by Area Agencies on Aging may help older adults avoid unnecessary nursing home placement; organizational capacity for implementation appears to be a prerequisite for impact. Policy Implications: Leveraging Area Agencies on Aging to deliver evidence- based health promotion programs for older adults could help avoid expensive nursing home placements but attention to management and organizational development will be critical.