Field of Work: Research on home and community-based services.
Problem Synopsis: Home and community-based services—ranging from skilled nursing and physical therapy to help with daily activities such as bathing and dressing—are vital to many people with chronic illness or disability. By 1995, these services had become the fastest growing component of health care spending in the United States, according to the Visiting Nurse Service of New York. In the mid-1990s, Michigan policy-makers recognized the need for a statewide effort to allocate long-term care services more equitably and rationally and, by doing so, to moderate the growth in long-term care expenditures.
Synopsis of the Work: From 1997 to 2001, researchers from the University of Michigan conducted development and evaluation work on the Michigan Managed Long-Term Care Initiative (since renamed MI Choice). It allows eligible adults to receive Medicaid-covered services—similar to those provided by nursing homes—in their homes or another residential setting. The project was part of the Robert Wood Johnson Foundation Home Care Research Initiative national program.
The development and implementation of an algorithm-based screening system. The system consists of a 15- to 20-minute telephone screen and, for those who are eligible for further assessment and possible program enrollment, a 60-minute in-person assessment.
The development of a set of 22 Home Care Quality Indicators to evaluate the care provided by home and community-based agencies. These indicators measure clinical conditions (e.g., nutrition, pain, physical function and hospital use) at a single point in time and client improvement or decline (e.g., incontinence and health instability) over time.
The MI Choice Screening System "algorithm" agrees with expert opinions substantially better than systems based on ADL and IADL.
The MI Choice telephone screen identifies potential program participants efficiently and economically, but callers exaggerate about how sick they (or the people they represent) are.
Clients in MI Choice had a positive change in 16 of 22 Home Care Quality Indicators.