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Wysocki A, Butler M, Kane RL, et al. Long-Term Care for Older Adults: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 81 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Jul. (Future Research Needs Papers, No. 44.)

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Long-Term Care for Older Adults: Future Research Needs: Identification of Future Research Needs From Comparative Effectiveness Review No. 81 [Internet].

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Conclusions

We identified specific research needs that should be useful in future efforts to address the effectiveness of LTC for older adults delivered through HCBS and in NHs. The clinical and policy context of LTC is changing. Comparative effectiveness may be less salient than understanding what makes such care effective in the first place for various client groups. Therefore, we reported research needs related to the comparison of HCBS and NH care that was the focus of the CER, and we also reported research needs from the broader set of questions that stakeholders felt were more important priorities in the current policy environment. Future research in this area will create a broader and stronger evidence base for making care and policy decisions:

  • What standardized outcome measures should be used for HCBS and NH recipients that fully measure benefits and harms and are capable of showing meaningful change?
  • What should be included in a taxonomy of HCBS and how do we measure a “service” to enable research across different types of HCBS?
  • What is the minimum set of potential outcomes for HCBS and NH recipients? For example, outcomes may include abuse, loneliness as an intermediate outcome that could predict institutionalization, transitions (likelihood of being discharged from a NH after an individual enters a NH, likelihood of going back to a NH after discharge from the NH, and likelihood of being rehospitalized after experiencing a hospitalization).
  • What quality-of-life measures and disease specific measures should be used to capture an individual's experience in LTC?
  • What should be included in a taxonomy for assisted living to assess the effectiveness of services and to compare to other HCBS?
  • What is the pattern of transitions of LTC users? What factors lead to transitions?
  • What works for whom? How does HCBS affect different subpopulations/subgroups?
  • How do outcomes of individuals in managed care programs differ from those of individuals in fee-for-service programs? Do managed LTC programs for dual eligibles offload costs onto Medicare?
  • What services within HCBS result in better outcomes for individuals?
  • How do policies, payment rates, and availability of services in different areas impact who does or does not receive HCBS?

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