Abstract
Person-centered care (PCC) in nursing homes is an elusive organizational goal that
has attracted the attention of pay-for-performance (P4P) programs. P4P programs are
used to incentivize providers to improve the quality of care delivered. However, P4P
programs have both overarching policy initiatives (big “P”) that must incorporate
an implementation framework that is adaptable in practice (little “p”). The purpose
of this paper is to apply six key factors that are central to P4P design in long-term
care settings: financial incentives, measurement, stakeholder involvement and alignment,
feasibility, education and awareness, and reporting and transparency as a framework
for a case study of a P4P initiative conducted in Ohio between 2015 and 2019. Notably,
the case study is focused on PCC and how the Ohio Department of Medicaid selected
the Preferences for Everyday Living Inventory (PELI) for nursing home providers to
use with all of their residents. Although inclusion of the PELI met some of the key
factors, such as measurement, its implementation did not meet other key factors, such
as reporting and transparency. Based on lessons learned from the Ohio P4P, recommendations
are presented for use of the PELI as both a process and outcome measure in future
P4P initiatives.
Keywords
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References
- The fundamentals of person-centered care for individuals with dementia.Gerontologist. 2018; 58: S10-S19
- The experience of dementia.Aging Mental Health. 1997; 1: 13-22
- Person-centered care: A definition and essential elements.J Am Geriatr Soc. 2016; 64: 15-18
- Development of a framework for person-centered nursing.J Adv Nurs. 2006; 56: 472-479
- Knowing the patient: A process model for individualized interventions.Nurs Res. 1995; 44: 364
- Individualized nursing care: An empirically generated definition.Int Nurs Rev. 2002; 49: 54-63
- Patient-centered care and adherence: Definitions and applications to improve outcomes.J Am Acad Nurse Pract. 2008; 20: 600-607
- Person-centered care in the early stages of dementia: Honoring individuals and their choices.Generations. 2012; 37: 30-36
- Individualized feeding assistance care for nursing home residents.J Gerontol. 2004; 59: 966-973
- Continence restoration in the cognitively impaired adult.Geriatr Nurs. 1998; 19: 87-90
- Assessing Satisfaction in Health and Long-Term Care.Springer, New York2000
- Psychosis, depression and behavioral disturbances in Sydney nursing home residents: Prevalence and predictors.Int J Geriatr Psychiatry. 2001; 16: 504-512
- Do interventions bringing current self-care practices into greater correspondence with those performed pre-morbidly benefit the person with dementia? A pilot study.Am J Alzheimers Dis Other Demen. 2006; 21: 312-317
- Evidence-based guideline. Individualized music for elders with dementia.J Gerontol Nurs. 2010; 36: 7-15
- Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial.J Am Geriatr Soc. 2004; 52: 1795-1804
- A stimulation-retreat special care unit for elders with dementing illness.Int Psychogeriatr. 1998; 10: 379-395
- The impact of past and present preferences on stimulus engagement in nursing home residents with dementia.Aging Mental Health. 2010; 14: 67-73
- The changing adoption of culture change practices in U.S. nursing homes.Innov Aging. 2020; 4: igaa012
- The Kansas PEAK 2.0 program facilitates the diffusion of culture-change innovation to unlikely adopters.Gerontologist. 2017; 58: 530-539
- Culture change practice in U.S. nursing homes: Prevalence and variation by state Medicaid reimbursement policies.Gerontologist. 2013; 54: 434-445
- Who are the innovators? Nursing homes implementing culture change.Gerontologist. 2014; 54: S65-S75
- Person-centered care as facilitated by Kansas' PEAK 2.0 Medicaid Pay-for-Performance Program and nursing home resident clinical outcomes.Innov Aging. 2018; 2: igy033
- The impact of nursing home pay-for-performance on quality and Medicare spending: Results from the nursing home value-based purchasing demonstration.Health Serv Res. 2017; 52: 1387-1408
- The effect of pay-for-performance in nursing homes: Evidence from state Medicaid programs.Health Serv Res. 2013; 48: 1393-1414
- Evaluation of the Nursing Home Value-Based Purchasing Demonstration.Centers for Medicare & Medicaid Services, Washington, DC2013
- An evaluation of performance thresholds in nursing home pay-for-performance.Health Serv Res. 2016; 51: 2282-2304
- Medicaid nursing home pay for performance: Where do we stand?.Gerontologist. 2009; 49: 587-595
- Pragmatic measures.Am J Prev Med. 2013; 45: 237-243
- Pay for performance in five states: Lessons for the nursing home sector.Public Adm Rev. 2013; 73: S153-S163
- Nursing home administrators' opinions of pay for performance.J Aging Soc Policy. 2014; 26: 229-248
- Examining the nursing home physical environment through policy-driven culture change.J Hous Elderly. 2018; 32: 241-262
- Tension between quality measurement, public quality reporting, and pay for performance.JAMA. 2013; 309: 349
- The conceptual basis for dissemination and implementation research: Lessons from existing models and frameworks.in: Brownson R.C. Colditz G.A. Proctor E.K. Dissemination and Implementation Research in Health: Translating Science to Practice. 2nd ed. Oxford University Press, New York2018: 73-88
- Nursing facility provider update.(Available at:)https://www.leadingageohio.org/aws/LAO/asset_manager/get_file/117615Date accessed: November 11, 2020
- The Preferences for Everyday Living Inventory: Scale development and description of psychosocial preferences responses in community-dwelling elders.Gerontologist. 2013; 53: 582-595
- The psychosocial preferences of older adults: An examination of content and structure.Gerontologist. 2000; 40: 335-348
- The change in nursing home residents' preferences over time.J Am Med Dir Assoc. 2018; 19: 1092-1098
- Do family proxies get it right? Concordance in reports of nursing home residents' everyday preferences.J Appl Gerontol. 2017; 36: 667-691
- A preference-based model of care: An integrative theoretical model of the role of preferences in person-centered care.Gerontologist. 2020; 60: 376-384
- Cognitive interviewing: Revising the Preferences for Everyday Living Inventory (PELI) for use in the nursing home.Res Gerontol Nurs. 2016; 9: 24-34
- The consistency of self-reported preferences for everyday living: Implications for person-centered care delivery.J Gerontol Nurs. 2014; 40: 34-46
- The impact of nursing home residents’ characteristics on ratings of importance of autonomy preferences in daily care over time.Aging Ment Health. 2020; 24: 1334-1341
- Development and validation of a revised nursing home assessment tool: MDS 3.0. Report for Centers for Medicare & Medicaid Services, US Department of Health and Human Services.(Available at:)https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/downloads/MDS30FinalReport.pdfDate: 2009Date accessed: July 8, 2021
- Focused dementia care survey tools.(Available at:)
- PEAK 2.0 Handbook.(Available at:)https://www.hhs.k-state.edu/aging/outreach/peak20/2020-21/Handbook-2020-2021.pdfDate accessed: November 11, 2020
- PELI- Preferences for Everyday Living Inventory, OHCA White paper.(Available at:)https://custom.cvent.com/1FFFF1FED2354F508C73773ED6FF5432/files/757eb5b5b9fd4b829c383f8f578f5e69.pdfDate accessed: March 18, 2021
- Ohio Department of Medicaid.(Available at:)
Article info
Publication history
Published online: July 05, 2021
Footnotes
The authors declare no conflicts of interest.
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