The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA.
Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA.
Gerontologist. 2024 Jun 1;64(6). doi: 10.1093/geront/gnae017.
Person-centered planning (PCP) allows recipients of home- and community-based service (HCBS) to plan services and supports according to their preferences and needs. The extent to which HCBS systems engage in PCP and evidence for the relationship between PCP and beneficiary outcomes are limited. We examine the prevalence of PCP among HCBS recipients and the relationship between PCP and person-reported outcomes.
We used the 2018-2019 National Core Indicators-Aging and Disability survey, collected among adult Medicaid HCBS recipients in 12 states (n = 5,849). We examined 2 general PCP measures (1 on decision making and another on whether service plans reflected preferences/choices). We also constructed a scale to assess the fidelity of recipients' service planning meeting to the PCP process. Outcomes included unmet service needs and community living (i.e., participation, control, and satisfaction). We examined recipient characteristics associated with PCP and used adjusted logistic regression models to assess the relationship between PCP and outcomes.
About 72% of HCBS recipients were involved in decision making, 72% reported their service plan reflected their preferences/choices, and 47% had meetings that scored "high fidelity" on the PCP fidelity scale. PCP measures were consistently related to lower likelihood of unmet service needs and greater likelihood of experiencing community living outcomes.
Findings suggest PCP is important for adequately meeting service needs and ensuring community living among HCBS beneficiaries. Additional standardized measures should be developed to facilitate quality improvement and accountability for delivering person-centered HCBS.
以人为中心的规划（PCP）允许家庭和社区为基础的服务（HCBS）的接受者根据他们的喜好和需求来规划服务和支持。HCBS 系统参与 PCP 的程度以及 PCP 与受益结果之间关系的证据是有限的。我们检查了 HCBS 接受者中 PCP 的流行程度以及 PCP 与个人报告结果之间的关系。
我们使用了 2018-2019 年国家核心指标-老龄化和残疾调查，该调查是在 12 个州的成年医疗补助 HCBS 接受者中收集的（n=5849）。我们检查了 2 项一般 PCP 措施（1 项关于决策，另一项关于服务计划是否反映了偏好/选择）。我们还构建了一个评估接受者服务规划符合 PCP 过程的忠实度的量表。结果包括未满足的服务需求和社区生活（即参与、控制和满意度）。我们检查了与 PCP 相关的接受者特征，并使用调整后的逻辑回归模型来评估 PCP 与结果之间的关系。
约 72%的 HCBS 接受者参与了决策，72%的人报告他们的服务计划反映了他们的偏好/选择，47%的人在 PCP 忠实度量表上的会议得分“高忠实度”。PCP 措施与较低的未满足服务需求和更大的社区生活体验可能性始终相关。
研究结果表明，PCP 对于充分满足服务需求和确保 HCBS 受益人的社区生活是很重要的。应该开发更多的标准化措施，以促进提供以人为中心的 HCBS 的质量改进和问责制。
