Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.

Hass Z1, Woodhouse M2, Grabowski DC3, Arling G4.

Author information

1: Schools of Nursing and Industrial Engineering & Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana.
2: School of Public Health, University of Minnesota, Minneapolis, Minnesota.
3: Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts.
4: School of Nursing, Purdue University, West Lafayette, Indiana.

Abstract

OBJECTIVE:

To evaluate Minnesota's Return to Community Initiative's (RTCI) impact on community discharges from nursing homes.

DATA SOURCES:

Secondary data were from the Minimum Data Set and RTCI staff (April 2014 - December 2016). The sample consisted of 18 444 non-Medicaid nursing home admissions in Minnesota remaining for at least 45 days, with high predicted probability of community discharge.

STUDY DESIGN:

The RTCI facilitates community discharge for non-Medicaid nursing home residents by assisting with discharge planning, transitioning to the community, and postdischarge follow-up. A key evaluation question is how many of those transitions were directly attributable to the program. Return to Community Initiative was implemented statewide without a control group. Program impact was measured using regression discontinuity, a quasi-experimental design approach that leverages the programs targeting model.

PRINCIPAL FINDINGS:

Return to Community Initiative increased community discharge rates by an estimated 11 percent (P < 0.05) for the targeted population. The program effect was robust to time and increased with level of facility participation in RTCI.

CONCLUSIONS:

The RTCI had a modest yet significant impact on the community discharge rates for its targeted population. Findings have been applied in strengthening the RTCI's targeting approach and transitioning process.