Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.
Independent Research Consultant, Ardmore, PA, USA.
J Am Med Dir Assoc. 2024 Oct;25(10):105224. doi: 10.1016/j.jamda.2024.105224. Epub 2024 Aug 17.
In 2015, the Ohio Department of Medicaid incentivized use of the Preferences for Everyday Living Inventory (PELI) as a quality initiative. The pay-for-performance (P4P) program, however, was then deimplemented in 2019. This study investigated the sustainability of use of the PELI in Ohio nursing homes (NHs) from 2017 to 2021 and examined barriers to PELI implementation.
This study analyzed 2 waves of Ohio Biennial Survey of Long-Term Care Facilities data.
Data were drawn from 433 NHs in Ohio that reported on PELI implementation efforts between 2017 and 2021.
This study examined the change in proportion of NHs implementing the PELI (ie, conducted for all residents, used in care planning) and change in proportion of NHs using different PELI assessment formats (ie, the full 72-item PELI, MDS 3.0 Section F items only). Frequencies of reported barriers to PELI implementation by NH administrators were tabulated.
Results indicate that although use of the full 72-item PELI decreased over time, only a small percentage discontinued its use despite possible impacts of P4P changes in 2019 and challenges posed by the COVID-19 pandemic. NHs adapted their PELI assessment formats likely in response to perceived barriers of PELI use (ie, length of the full PELI, time constraints, and residents' level of cognitive impairment).
Findings suggest that Ohio NHs sustained PELI implementation over time in the context of large systemic changes in P4P financial incentives and COVID-19 safeguards. Barriers were reported at the organizational level, yet NHs continued to prioritize PCC with the PELI. Policy/P4P mandates may serve as effective implementation incentives that encourage sustainability of quality care practices. Future research should explore long-term sustainability and stakeholder perspectives on PELI utilization.
2015 年，俄亥俄州医疗补助部将使用日常生活偏好量表（PELI）作为一项质量计划进行激励。然而，该按效付费（P4P）计划于 2019 年被取消。本研究调查了 2017 年至 2021 年俄亥俄州养老院（NH）持续使用 PELI 的情况，并探讨了实施 PELI 的障碍。
本研究分析了俄亥俄州两次长期护理设施年度调查数据。
数据来自俄亥俄州的 433 家 NH，这些 NH 在 2017 年至 2021 年期间报告了 PELI 的实施情况。
本研究考察了实施 PELI 的 NH 比例的变化（即对所有居民进行、用于护理计划）和 NH 使用不同 PELI 评估格式的比例的变化（即完整的 72 项 PELI，仅 MDS 3.0 第 F 项）。列出了 NH 管理员报告的 PELI 实施障碍的频率。
结果表明，尽管完整的 72 项 PELI 的使用随着时间的推移而减少，但尽管 2019 年 P4P 变化的影响和 COVID-19 大流行带来的挑战，只有一小部分 NH 停止使用 PELI。NH 可能会调整其 PELI 评估格式，以应对 PELI 使用的感知障碍（即完整 PELI 的长度、时间限制和居民的认知障碍程度）。
研究结果表明，在 P4P 财务激励和 COVID-19 保护措施发生重大系统变化的情况下，俄亥俄州 NH 能够随着时间的推移持续实施 PELI。报告了组织层面的障碍，但 NH 仍继续将 PELI 作为 PCC 的重点。政策/P4P 授权可能是鼓励优质护理实践可持续性的有效实施激励措施。未来的研究应该探索 PELI 使用的长期可持续性和利益相关者的观点。
