Abstracts of DALTCP REPORTS--"M" Titles

This section gives abstracts for reports produced through DALTCP-funded research or through research done by DALTCP staff. Links to Executive Summaries and/or Full Reports immediately follow most descriptions, as well to Project Descriptions (if available). (We are working towards putting ALL Full Reports online.) Reports can be ordered from the Office of Disability, Aging and Long-Term Care Policy, unless stated otherwise. Requests can be made by Fax (202-401-7733) or through email (webmaster.DALTCP@hhs.gov).

NOTE: Because of the large number of DALTCP reports, abstracts are divided into several files.

Remember, the Site Index section includes an alphabetic list of keywords you can choose to find information that is referenced throughout the DALTCP website.

MANAGED CARE AND PEOPLE WITH DISABILITIES RESEARCH PROJECT DESCRIPTIONS

ABSTRACT: In an effort to better understand the impact of managed care on disabled populations, ASPE staff, in collaboration with the Health Care Financing Administration, have developed a series of research and evaluation efforts focused on managed care and people with disabilities. This research plan includes a variety of projects to promote knowledge on the experiences of disabled populations in managed care in public health care systems such as Medicaid and Medicare, as well as in employer-based and self-insured plans. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

MANAGED CARE FOR PEOPLE WITH DISABILITIES RESEARCH INVENTORY

ABSTRACT: No abstract available at this time. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

MEASURING THE ACTIVITIES OF DAILY LIVING AMONG THE ELDERLY: A GUIDE TO NATIONAL SURVEYS

ABSTRACT: The activities of daily living (ADLs) are the basic task of everyday life: eating, bathing, dressing, toileting, and transferring. Although persons of all ages may have problems performing ADLs, disability prevalence rates are much higher for the elderly--rising steeply with advancing age. When an effort is made to standardize ADL items for comparison, estimates for the community-based population vary by no more than 3.1 percentage points and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. The main conclusion is that ADL estimates will differ for good reasons and that there is no one "right" estimate. Researchers and policy analysts alike need to be aware that ADL disability rates are simply much "softer" measure than, say, mortality rates. From wording decisions made by those designing the survey questionnaire, to analysts who chose a particular ADL question(s) to analyze and report, to programmers who handle multiple question recodes and deal with missing and inconsistent data, each step will influence the final results. Thus, even an extremely large sample could not provide a definitive estimate. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-151829]

MEASURING THE ACTIVITIES OF DAILY LIVING: COMPARISONS ACROSS NATIONAL SURVEYS

ABSTRACT: The activities of daily living (ADLs) are the basic tasks of everyday life. Reported estimates of the size of the elderly population with ADL disabilities differ substantially across national surveys. Differences in which ADL items are being measured and in what constitutes a disability account for much of the variation. Other likely explanations are differences in sample design, sample size, survey methodology, and age structure of the population to which the sample refers. When essentially equivalent ADL measures are compared, estimates for the community-based population vary by up to 3.1 percentage points; and for the institutionalized population, with the exception of toileting, by no more than 3.2 percentage points. As small as these differences are in absolute terms, they can be large in percent differences across surveys. This article describes 11 recent surveys and how their ADL differences can effect policy analysis. (Journal of Gerontology: SOCIAL SCIENCES, November 1990, Volume 45, Number 6, Pages S229-237) [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB94-144375, 13 pages]

MEDICAID BUY-IN PROGRAMS: CASE STUDIES OF EARLY IMPLEMENTER STATES

ABSTRACT: This paper describes the findings from nine Case Study states. These case studies were conducted: (1) To examine early implementation experience among the states in order to gain an understanding of the programmatic, fiscal, and political context in which design decisions were made. (2) To gather quantitative and qualitative descriptive information for use in providing technical assistance to other states regarding the range and scope of state approaches to enable state policy makers to make informed decisions. (3) To inform federal policy makers and other stakeholders about issues associated with Medicaid Buy-In programs. [143 pages]

MEDICAID BUY-IN PROGRAMS: LESSONS LEARNED FROM NINE "EARLY IMPLEMENTER" STATES

ABSTRACT: This report discusses findings from case studies of nine states--Alaska, Connecticut, Iowa, Maine, Minnesota, Nebraska, Oregon, Vermont and Wisconsin--operating Medicaid Buy-In programs for working persons with disabilities. At the time of this study, approximately 13,000 persons were enrolled in the programs in these nine states. The paper gives particular attention to the decisions made by states concerning program eligibility, their approaches to estimating program enrollment and costs, and the patterns of program enrollment to date. [36 pages]

MEDICAID PERSONAL CARE SERVICES OPTION

ABSTRACT: This was a two-part ASPE Research Notes article. Part I (Cross-State Variations and Trends Over Time) provided a descriptive overview of Medicaid personal care services programs. Part II (Consumer-Directed Models of Care) was published December 1994. It compares models of care that promote greater or lesser degrees of consumer control or choice, and discusses research findings associating greater consumer satisfaction with increased choice. It concludes by discussing the relationship of these variables to indicators of worker satisfaction and worker pay and benefits, and by signaling some unanswered questions.

MEDICAID SPENDDOWN IN NURSING HOMES AND THE COMMUNITY

ABSTRACT: This paper employs information from nationally representative surveys to examine the incidence and causes of Medicaid spenddown among disabled elderly persons. About 10% of nursing home discharges experience "asset spenddown," the process of converting from private pay to Medicaid. In contrast, over 50% of nursing home patients remain private pay throughout their stays. The incidence of spenddown to Medicaid in the community is greater than the incidence of spenddown in nursing homes, and appears to be more strongly related to medical care costs than community-based long-term care costs. Implications of findings for health care policies are discussed. (LTC Financing GENERATIONS, Spring 1990, XIV(2):10-14) [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB91-106922, 30 pages]

MEDICARE HOME HEALTH SERVICES 1989-1994: PATTERNS OF BENEFIT USE AMONG CHRONICALLY DISABLED ELDERS

ABSTRACT: No abstract available at this time. (Gerontological Society of America presentation, November 1998)

MEDICARE POST-ACUTE CARE: QUALITY MEASUREMENT FINAL REPORT

ABSTRACT: This report is presented in five chapters. Chapter I provides an overview of the project. Chapter II develops the rationale for conducting this project. Chapter III describes how quality measures for selected conditions were identified and selected, and how quality measurement instruments were developed and refined. Chapter IV summarizes the quality measures chosen for the selected tracer conditions across post-acute care services and the limitations of existing administrative data (including patient assessment information) in measuring outcomes. The last chapter briefly describes the next phase of the ASPE research strategy to examine post-acute care quality. Finally, the Appendices include several background and supporting documents, as referenced throughout this report.

MEDICARE'S HOSPICE BENEFIT: USE AND EXPENDITURES, 1996 COHORT

ABSTRACT: This report presents information on Medicare's hospice benefit--who is using it, how it is being used, what costs are associated with its use, what costs precede hospice enrollment and how these vary by type of enrollee. This information will be important for understanding the role of Medicare's hospice benefit in the context of the other benefits Medicare provides to one of the program's most expensive populations--the terminally ill--and understanding whether the current policies meet the needs of the population enrolling in hospice. Also included are snapshot contrasts of two groups of enrollees--those who were enrolled in HMOs or on Medicaid at least once during the 12 months between July 1995 and July 1996.

MEDICARE'S POST-ACUTE CARE BENEFITS: BACKGROUND, TRENDS, AND ISSUES TO BE FACED

ABSTRACT: ASPE funded the Urban Institute to synthesize trends and issues with Medicare post-acute care benefits. Rapidly rising expenditures for home health, skilled nursing facility, and rehabilitation and long-term care hospital services have caused policymakers to focus considerable attention on these benefits. The Balanced Budget Act (BBA) of 1997 mandated a myriad of reforms, primarily payment reforms, for these services. However, long-standing coverage, eligibility, and certification policies remained largely unchanged. This paper summarizes what is known about Medicare's post-acute care benefits, including a discussion of trends in expenditures; characteristics and outcomes of post-acute care users; payment reforms included in the BBA; and cost, quality, and access issues not addressed by the BBA.

MEDICATION USE BY MEDICARE BENEFICIARIES LIVING IN NURSING HOMES AND ASSISTED LIVING FACILITIES

ABSTRACT: This report compares the medication use of Medicare beneficiaries living in nursing homes and assisted living facilities. Descriptions of medicare use include mean number of drug mentions per month of stay (scheduled and PRN drugs), and prevalence and duration of therapy by major drug classes. Characteristics of institutionalized beneficiaries include demographics, income, regional residence, Medicare supplemental coverage, any community residence or skilled nursing stays, death, health status, activities of daily living scores, and major medical conditions.

MEDICATION USE IN LONG-TERM CARE FACILITIES AND COMMUNITY SETTINGS FOR MEDICARE BENEFICIARIES WITH CARDIOVASCULAR DISEASE

ABSTRACT: This report compares medication use in long-term care facilities and community settings for Medicare beneficiaries with heart conditions. The purpose of this comparison was to evaluate the utility of a new file of institutional drug use in the Medicare Current Beneficiary Survey (MCBS), the premier source of health care information on the Medicare population. Descriptions of medication use include the prevalence of drugs from 12 cardiovascular drug classes and 28 other major therapeutic drug categories. Characteristics of beneficiaries include type of heart disease, co-morbidities, functional levels and health status, demographics, Medicare supplemental coverage, and regional residence.

MEETING THE CHALLENGE OF SERVING PEOPLE WITH DISABILITIES: A RESOURCE GUIDE FOR ASSESSING THE PERFORMANCE OF MANAGED CARE ORGANIZATIONS

ABSTRACT: This Resource Guide is designed to support efforts to measure and improve Medicaid managed care organization (MCO) performance for people with disabilities. It presents the results of an extensive search for existing performance measures that can be used for quality measurement and improvement by: state Medicaid agencies; MCOs themselves; providers within MCOs; and people who advocate for the health care needs of those with disabilities. The purpose of the Resource Guide is threefold: (1) To provide an overview of the issues to be considered in measuring the performance of MCO in taking care of people with disabilities. (2) To bring together in one volume key information about measures that now exist, or are about to be made available, that can be counted on to support efforts to measure and improve the care provided by MCOs to people with disabilities. (3) To make clear the areas where technically strong measures do not exist, in order to encourage further measurement development in these areas. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #]

METHODOLOGICAL ISSUES IN THE EVALUATION OF THE NATIONAL LONG-TERM CARE DEMONSTRATION

ABSTRACT: This report describes the methodology used throughout the evaluation of the National Long-Term Care Channeling Demonstration and documents the major analytical issues that posed potential threats to the credibility of the analysis. It provides a more thorough explanation of the estimation procedures and test statistics employed and summarizes the investigations of specific methodological issues. These issues include sample composition, data collection procedures and estimation techniques. The one issue that might lead to distorted estimates of program impacts is the non-comparability of baseline data, based on differences in collecting data from the treatment and control groups. To avoid this distortion, baseline variables judged to non-comparably measured were excluded from use as control variables in the regression equations; where possible, they were replaced by counterparts from the initial screening instrument. All other potential problems were found to have little or no actual effect on impact estimates or their interpretation. [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov, Accession #PB86-239977]

MICHIGAN'S TRANSITIONING PERSONS FROM NURSING HOMES TO COMMUNITY LIVING PROGRAM

ABSTRACT: This paper--which is one of a series of Appendices which will be included in the demonstration's final report--describes a case study of the Michigan Nursing Home Transition Demonstration program. It is based on a two-day site visit conducted in January 2001, follow-up interviews in January 2002, and written reports from the State of Michigan and the Michigan Association of Centers for Independent Living. The report describes the program under the Centers for Medicare and Medicaid Services grant, the program's transition to a state-funded grant, and the program's results. The report then discusses how program staff responded to barriers to successful transition, and how nursing home transition funding continued in Michigan.

MULTIVARIATE ANALYSIS OF DISABILITY AND HEALTH, AND ITS CHANGE OVER TIME IN THE NATIONAL CHANNELING DEMONSTRATION DATA

ABSTRACT: The Channeling Demonstration examined the effects of case management interventions on a variety of outcomes. In the study, longitudinal data were collected from interviews of cases and controls. A multivariate procedure applied to this data identified groups with specific health profiles. Six profiles described health variation over individuals, and time, according to likelihood ratio statistics. Six sets of life tables were calculated, one for each health profile, to estimate the average duration of service use and the "follow-up" services used. A number of differences, and changes, in service use between the six groups were significant. (The Gerontologist, Volume 33, Number 5, 1993, Pages 610-618) [Order this report from National Technical Information Service (NTIS), Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161, Website http://www.ntis.gov]

MULTIVARIATE ANALYSIS OF PATTERNS OF INFORMAL AND FORMAL CAREGIVING AMONG PRIVATELY INSURED AND NON-PRIVATELY INSURED DISABLED ELDERS LIVING IN THE COMMUNITY

ABSTRACT: The purpose of this report is to enhance understanding of the factors associated with privately insured and non-privately insured groups, and to begin to identify the independent effect or role played by long-term care insurance. The authors also analyze the underlying dimensions of satisfaction that are related to the claimant's evaluation of the insurance policy.

Last revised: February 25, 2003

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