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Future Directions for Residential Long-term Care Health Services Research

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In October 1999, AHRQ's Center for Organization and Delivery Studies (CODS) and Center for Cost and Financing Studies (CCFS) sponsored, "Future Directions for Residential Long-term Care Health Services Research." The meeting of long-term care experts was convened to help guide the Agency in developing its long-term care agenda and provide advice on alternative approaches to data collection.

The 2-day discussion was based on experts' responses to a series of questions collected prior to the meeting. The questions focused on policy and research priorities, national quality indicators, and data collection methods.

The first day of the meeting included the following discussions:

  • Participants were asked to list their top research and policy questions concerning residential long-term care. Their responses reflected a number of concerns in six major categories: cost effectiveness, equity/access, financial and market incentives, consumer issues, quality assurance, and methodology.
  • Expert opinion also was solicited about quality measures and associated risk factors that could be used to monitor changes in quality over time. The following issues were stressed during the discussion:
    • Participants generally conceptualized residential long-term care as all of the care provided in residential care settings (e.g., personal care, quality of life associated with home environment, acute and preventive care). They included both quality of care and quality of life.
    • Participants discussed outcome, process and structural measures, although they viewed process as more difficult to measure.
    • Experts agreed that quality of life indicators and evaluation of clinical management are high priorities, but believed that these areas need more methodological development. They also felt that for an outcome measure to be used as a quality indicator, evidence must show that the outcome is malleable and that a facility has control over changing that outcome. If a process or structural measure is used as a quality indicator, evidence must show that those measures affect resident outcomes.

On day 2 of the meeting, presenters highlighted major features of national long-term care surveys and administrative data systems, and discussed departmental goals associated with data integration.

Experts recommended that the following data be collected:

  • Demographic and health characteristics of residents.
  • Facility characteristics, including services provided and hotel-type amenities offered.
  • Services received by each resident.
  • Health outcomes.
  • Payment information, including costs and revenues.
  • Market information and prices.
  • Longitudinal information about the transitions of residents to and between health care settings.

During the afternoon of day 2, discussion focused on alternative strategies for data collection, leading to the following consensus recommendations:

  • Develop a facility frame that includes the full continuum of long-term care facilities.
  • Collect data on persons in all types of residential settings, not just nursing homes.
  • Obtain longitudinal information about changes in health status and care received while following persons across settings.
  • Utilize both facility-based and person-based sampling designs.
  • Improve facility and market data.
  • Select a sufficient sample size to study subpopulations.

Participants discussed alternative ways to reach these goals, including:

  1. How to construct a comprehensive frame.
  2. Increase the Medicare Current Beneficiary Survey (MCBS) sample size of persons in long-term care settings.
  3. Conduct specialized, periodic surveys.
  4. Explore the feasibility of supplementing survey data with administrative data.

A summary of the expert meeting will be available as of June 2000. To obtain a copy of this summary or for more information about residential long-term care health services research, contact William Spector at AHRQ's Center for Organization and Delivery Studies (E-mail:

Current as of April 2000

The information on this page is archived and provided for reference purposes only.


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