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Future Directions for Community-Based Long-Term Care Health Services Research

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Table 1. Summary of Quality Dimensions

Organization and
delivery
Equity/access Financial and market issues Consumer issues Quality Methodology

Assess the effect of organizational factors on home care use.

Assess the role of physicians, nurses, and other providers in community care.

Assess the costs and benefits of existing models

  • Consumer-directed care.
  • Program of All Inclusive Care for the Elderly (PACE).
  • Social health maintenance organizations (SHMOs).
  • Continuing care retirement communities (CCRCs).
  • Family care.
  • Home care.
  • Hospice care.
  • Adult day care.
  • Chronic care for children.

Develop new models

  • Housing/neighborhood-
    based care.
  • Team-based care.

Assess the effect of long-term care program design

  • Eligibility.
  • Resource allocation.
  • Financing/caps.
  • Consumer-directed.
  • Case management.

Measure and reduce disparities across race, ethnicity, and gender.

Understand different cultural models of care.

Study the integration of long- term care with educational services for children.

Monitor State long-term care program variations and assess impact on access to care.

Monitor variations in scope and intensity of children's services.

Assess access to affordable housing and transportation for adults with disabilities.

Influence of financing on equity/access

Monitor distribution of home care expenditures across payment sources (Medicare, Medicaid, private pay, out-of-pocket).

Reduce barriers to services created by categorical funding.

Assess influence of insurance coverage on access to services.

Barriers to access for children

Assess impact of "medically needy" rules.

Identify additional barriers to services for low-income children.

Financing of care

Evaluate the impact of aging of population on approaches to financing long-term care.

Impact of Medicare home care prospective payment on:

  • Access use, quality, and cost.
  • Acute care, informal care, and community services.

Market issues

Monitor changes resulting from growth in managed care and assisted living.

Evaluate models of care that expand consumer choices and incorporate consumer preferences.

Family caregiving

Monitor trends in caregiving especially for children and adults with disabilities.

Assess factors influencing decisionmaking, especially effect of formal care on informal care.

Assess caregiver burden and evaluate approaches to burden reduction.

Assess and reduce elder abuse.

Identify approaches to preventing caregiver health problems.

Support for families

Improve quality information to consumers (e.g., report cards).

Develop services to promote self-directed care.

Develop nonregulatory-based approaches to quality assurance.

Understand "dose-response" in home care.

Assessment

Develop standards of care for long-term care.

Monitor safety of care and home environment.

Monitor patient's quality of life.

Evaluate quality of care for board-and-care facilities.

Evaluate impact of informal caregiving on quality of care.

Assess unmet needs.

Care transitions

Assess transition decisions.

Evaluate the costs and benefits of care settings.

Care provision

Determine staffing and skill mix.

Identify best approaches to retaining long-term care staffing and assuring adequate training.

Evaluate medication management.

Develop measures of:

  • Consumer satisfaction specific to home care, adult day care, and other services/settings.
  • Risk-adjusted outcomes.
  • Processes of care.
  • Functioning for children.
  • Long-Term care needs among children.
  • Quality for cognitively impaired.
  • Quality for informal care.
  • Projections of long-term care needs.

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