MDS Analysis

Article PDF:

JAMDA - Randomized MLI 13(1) 2012.pdf

Abstract:

Purpose: A comprehensive multilevel intervention was tested to build organizational capacity to create and sustain improvement in quality of care and subsequently improve resident outcomes in nursing homes in need of improvement. Intervention facilities (n=29) received a two-year multilevel intervention with monthly on-site consultation from expert nurses with graduate education in gerontological nursing. Attention control facilities (n=29) that also needed to improve resident outcomes received monthly information about aging and physical assessment of elders.

Design and Methods: Randomized clinical trial of nursing homes in need of improving resident outcomes of bladder and bowel incontinence, weight loss, pressure ulcers, and decline in activities of daily living (ADL). It was hypothesized that following the intervention, experimental facilities would have better resident outcomes, higher quality of care, higher staff retention, more organizational attributes of improved working conditions than control facilities, similar staffing and staff mix, and lower total and direct care costs.

Results: The intervention did improve quality of care (p=0.02); there were improvements in pressure ulcers (p=0.05), weight loss (p=0.05). Staff retention, organizational working conditions, staffing, and staff mix and most costs were not affected by the intervention. Leadership turnover was surprisingly excessive in both intervention and control groups.

Implications: Some facilities that are in need of improving quality of care and resident outcomes are able to build the organizational capacity to improve while not increasing staffing or costs of care. Improvement requires continuous supportive consultation and leadership willing to involve staff and work together to build the systematic improvements in care delivery needed.

Key words: randomized clinical trial, nursing homes, outcomes of care, cost analysis, quality improvement, staff retention, working conditions

Article PDF:

RGN - AIP 5(2) 2012.pdf

Abstract:

OBJECTIVES: To compare the cost to the Medicare and Medicaid programs between a community-based long-term care program called “Aging in Place” (AIP) and nursing home care.

DESIGN: A retrospective cohort design where AIP participants were matched to nursing home residents on admission quarter, age, ADL, and cognitive status and followed for 12 months. SETTING and PARTICIPANTS: A total of 39 nursing home residents in the same and neighboring counties in the Midwest were matched with 39 AIP participants.

INTERVENTION: The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination.

MEASUREMENT: Total cost to payor using Medicare and Medicaid claims databases.

RESULTS: Controlling for high inpatient Medicare cost in the six months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were $1591.61 lower in the AIP group (p < .01) when compared to the nursing home group over a 12 month period.

CONCLUSION: The provision of nurse coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.

Key words: older adults, long-term care, care coordination, home and community-based care, Medicaid costs, Medicare costs

Abstract:

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