RESUMEN
In response to increasing Medicaid expenditures and consumer preferences, states are reforming their long-term care systems to provide more community-based services. One popular reform is renewed efforts to prevent unnecessary long-term nursing home placement (diversion) and to provide nursing home residents an opportunity to return to the community (transition). Nearly 3,800 individuals, 60 years old and older, participated in Ohio's statewide nursing home diversion and transition initiative between March 2010 and May 2011. This research tracked outcomes for consumers and evaluated the implementation of the new program. Nearly 80% of diversion and transition participants who were still living at the time of their 6-month follow-up were residing in the community. An agency-level process analysis revealed innovative intervention strategies, promising practices, and barriers. Process results found that Area Agencies on Aging (AAAs) have become more proactive in working with high-risk individuals, with agencies identifying new at-risk consumers through hospital and nursing home interventions.
Asunto(s)
Servicios de Salud Comunitaria , Desinstitucionalización , Servicios de Atención de Salud a Domicilio , Hogares para Ancianos , Medicaid , Casas de Salud , Anciano , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/estadística & datos numéricos , Costos y Análisis de Costo , Desinstitucionalización/organización & administración , Desinstitucionalización/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Hogares para Ancianos/economía , Hogares para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Masculino , Casas de Salud/economía , Casas de Salud/estadística & datos numéricos , Innovación Organizacional/economía , Desarrollo de Programa , Medición de Riesgo , Estados UnidosRESUMEN
PURPOSE: A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. DESIGN AND METHODS: The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. RESULTS: A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. IMPLICATIONS: NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.
Asunto(s)
Difusión de Innovaciones , Medicina Basada en la Evidencia , Difusión de la Información , Casas de Salud/organización & administración , Investigación Biomédica Traslacional , Enfermería Geriátrica , Servicios de Salud para Ancianos , Humanos , Cultura OrganizacionalRESUMEN
The Minimum Data Set (MDS) is a uniform instrument used in nursing homes to assess residents. In January 2008, the Centers for Medicare and Medicaid Services published a draft of a new MDS-version 3.0. This article traces the instrument's development and the design decisions that shaped it, discusses the MDS's manifest functions-data collection intended to drive quality improvement and the unintended consequences of its use-paper compliance and diminished attention to resident quality of life, and examines the revised version to gauge its success in meeting the instrument's objectives. Although results of the national evaluation of MDS 3.0 are promising, the revisions, especially those pertaining to quality-of-life assessment and the use of resident interviews and standardized assessment procedures, raise questions for future consideration. Additionally, past research suggests that the MDS's impact on quality-of-care improvement will be limited unless efforts are directed toward resolving the industry's persistent struggles with staffing, survey effectiveness, and the development of feasible care processes. MDS 3.0 seems most likely to achieve its potential if it operates within a multifaceted quality improvement framework.
Asunto(s)
Evaluación Geriátrica/métodos , Casas de Salud , Anciano , Centers for Medicare and Medicaid Services, U.S. , Evaluación Geriátrica/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Indicadores de Calidad de la Atención de Salud , Estados UnidosRESUMEN
Based on data from an eight year longitudinal study of Ohio's long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future.