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Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults

Long-term Care Issues


Dr. Laura Reif, Director, Graduate Program in Gerontological Nursing, University of California-San Francisco (UCSF).

Kathleen E. Schuler, Project Coordinator, Minnesota Disability Health Options Project (MnDHO).

Christopher Duff, President and Chief Executive Officer (CEO), AXIS Healthcare.

Long-term care is more than health care. It affects where a person lives and the choices a person can exercise. Dr. Reif, Ms. Schuler, and Mr. Duff all reported that people with long-term care needs express different expectations in defining health care quality that include:

  • Focus on the whole person.
  • Self-determination.
  • Disability competence.
  • Integrated service coordination.
  • Supports for independent living.
  • Choice and flexibility in home care.
  • Accessibility.

Consumers in Minnesota worked closely with the State to design the MnDHO program to serve adults with physical disabilities. Ms. Schuler and Mr. Duff explained that the program design emphasizes this consumer orientation and needs to be measured to assess program performance. The MnDHO program's features include:

  • Flexible benefits to respond to individual needs.
  • Reduction in red tape to authorize services.
  • Provision of information to allow people to take charge of their lives.
  • Close attention from care coordinators, doctors, and others to enrollee needs.
  • A focus on preventive care and self-care.
  • A process for ongoing consumer feedback.

An evaluation of San Francisco County's In-home Supported Services (IHSS) program, conducted by Dr. Reif, used outcome measures to assess the service delivery system's performance. The measures included:

  • Ability to adequately inform consumers about the program.
  • Responsiveness to consumer calls for help with problems.
  • Understanding of client/family needs.
  • Ability to determine appropriate number of service hours.
  • Timeliness of payment for homecare workers.

Both these programs are challenged to find ways to meaningfully engage consumers in the evaluation of their care. Cognitive impairments, fatigue, and physical disabilities limit the ability of consumers to respond to conventional survey methods.

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AHRQ Advancing Excellence in Health Care