Person-Centered Care as Facilitated by Kansas’ PEAK 2.0 Medicaid Pay-for-Performance Program and Nursing Home Resident Clinical Outcomes

Abstract

Purpose of the StudyPerson-centered care (PCC) is intended to improve nursing home residents’ quality of life, but the closer bonds it engenders between residents and staff may also facilitate improvements to residents’ clinical health. Findings on whether adoption ameliorates resident clinical outcomes are conflicting, with some evidence of harm as well as benefit. To provide clearer evidence, the present study made use of Kansas’ PEAK 2.0 Medicaid pay-for-performance (P4P) program, which incents the adoption of PCC. The program is distinctive in training facilities’ staff on adopting PCC through a series of well-defined stages and providing regular feedback about their progress.Design and MethodsA retrospective cohort study was performed with 349 Kansas facilities spread across several well-defined PCC adoption stages, ranging from nonadoption to comprehensive adoption. The outcomes were thirteen 2014–2016 Nursing Home Compare long-stay resident clinical measures and a composite measure incorporating only nonimputed data for those 13 outcomes. Observed facility demographic differences were controlled for with propensity score adjustment. Treatment effect analyses were run with each outcome, with the predictor variable of program stage.ResultsSeven of the 13 clinical measures plus the composite measure indicated better health for residents in homes at higher program stages, relative to those in nonparticipating homes, including a 49% lower prevalence of major depressive symptoms in strongly adopting facilities.ImplicationsThe findings suggest that greater PCC adoption through PEAK participation is associated with better quality of care. Policymakers in other states may want to consider implementing a program modeled on PEAK 2.0.

The Benefits of Culture Change in Nursing Homes—Obtaining Nationally Representative Evidence

“…As done by others, we chose important and widely tested MDS-derived quality indicators, those used by CMS to monitor NH quality. 4,11,15,16 Across the pre and post periods, we observed improvements in almost all of the quality outcomes in NHs that both increased (treatment) and did not increase (control) their culture change. This is good news and likely a consequence of CMS's quality monitoring.…”

“…It did advance past research in that it used national resident-level (not NH-level) data for analyses and evaluated the effect of increases in individual culture change domains rather than a global score or ranking. 4,10,11 To our knowledge, we were the first research team to leverage the federally mandated MDS to study the effects of NH culture change at the person level on a large scale. The use of "Big Data" such as administrative claims, electronic health records, and the MDS assessment has become an invaluable component of post-acute and long-term care research.…”

“…However, its impact is limited because researchers used NH-level quality indicator data, Centers for Medicare & Medicaid Services (CMS)ederived quality indicator rates, and measured overall culture change using 3 broad stages of adoption rather than more specific culture change measures. 4 We aimed to overcome these limitations by using enhanced methodology with resident-level longitudinal quality indicators, domain-specific culture change panel data from a nationally representative stratified sample of US NHs, and statistical methods that account for selection bias. 5 Our objective was to understand whether increases in culture change practice adoption in the domains of environment, staff empowerment, and resident-centered care are associated with improved resident-level quality outcomes.…”

Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures

“…Essentially, all providers were awarded the quality points because all they were asked to do was check a box in the cost report. Utilizing a pragmatic indicator to understand the extent to which the PELI has been implemented could support a tiered reimbursement approach that has been found to be more successful with PCC efforts (Cornelison et al, 2019; Hermer et al, 2018)…”

Determinants of Successful Nursing Home Accreditation

“…46 Facilities providing person-centered care are regarded as providing efficient and effective services. 47,48 Person-centered care alleviates residents' depressive symptoms, 49 improves their functional status, lowers infection rates, 50 and boosts both resident and employee satisfaction. 49 However, whether it directly improves other quality of care indicators, such as fall rate 51 and quality of life, 50 remains unclear.…”