Why not just ask the resident?

This research evaluated a draft preference assessment tool (draft-PAT) designed to replace the current Customary Routine section of the Minimum Data Set (MDS) for nursing homes. The draft-PAT was tested with a sample of nursing home residents to evaluate survey-level administration time and noncompletion rates, as well as item-level nonresponse rates, response distributions, and test-retest reliability. Modifications to the draft-PAT were then retested with a subsample of residents.

What the resident meant to say: use of cognitive interviewing techniques to develop questionnaires for nursing home residents.

Purpose: Emphasis on consumer-centered care for frail and institutionalized older adults has increased the development and adaptation of surveys for this population. Conventional methods used to pretest survey items fail to investigate underlying sources of measurement error. However, the use of the cognitive interview (CI), a method for studying how respondents answer survey items, is not well established or documented in this population.

Reduced mortality: the unexpected impact of a telephone-based care management intervention for older adults in managed care.

Objective: This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program (CA Program) designed to link those with high health care utilization to home- and community-based services.

Data Source: Secondary data from the CA Program, part of the California HealthCare Foundation's Elders in Managed Care Initiative.

Study Design: Randomized-control trial in which participants (N=781) were randomly assigned to intent-to-treat (ITT) and control groups.

Reductions in costly healthcare service utilization: findings from the Care Advocate Program.

Objectives: To determine whether a telephone care-management intervention for high-risk Medicare health maintenance organization (HMO) health plan enrollees can reduce costly medical service utilization.

Design: Randomized, controlled trial measuring healthcare services utilization over three 12-month periods (pre-, during, and postintervention).

Setting: Two social service organizations partnered with a Medicare HMO and four contracted medical groups in southern California.

Does payment structure influence change in physical functioning after rehabilitation therapy?

Purpose: To determine if there are differences by payment structure (Medicare managed care versus fee-for-service) in the duration and intensity of geriatric rehabilitation therapy treatments and measure their effect on change in physical functioning at discharge.

Methods: Sixty-eight Medicare managed care (MCO) and 32 fee-for-service (FFS) subjects from 3 skilled nursing facilities (SNFs) in Southern California answered the physical functioning dimension of the Sickness Impact Profile (SIP-PFD) before and after rehabilitation therapy. Patient characteristics at admission, therapy treatments, and discharge physical functioning were compared by payment structure using chi-square and t-tests; logistic and ordinary least squares (OLS) regressions were employed to determine significant predictors of enrollment in managed care and change in physical functioning at discharge.

Using interagency collaboration to serve older adults with chronic care needs: the Care Advocate Program.

This article describes the Care Advocate Program, an interagency collaborative effort that involved health care organizations, social service agencies, and an academic research center to improve chronic care service delivery to older adults. The article discusses existing barriers to effective chronic care delivery as well as concepts for successful collaboration. The article describes the multiple and often competing demands of stakeholders who undertake collaborative projects.

Partnering managed care and community-based services for frail elders: the care advocate program.

Objectives: To describe a demonstration program that uses master's-level care managers (care advocates) to link Medicare managed care enrollees to home- and community-based services, testing whether referrals to noninsured services can reduce service usage and increase member satisfaction and retention.

Design: Using an algorithm designed to target frail, high-cost users of Medicare insured healthcare services, the program partners PacifiCare's Secure Horizons and four of its medical groups with two social service organizations.

Setting: Three care advocates located in two community-based social services agencies using telephone interviews to interact with targeted elders living in the community.