Sharing State-Level Knowledge to Improve Care for Nursing Home Residents

“AHRQ fulfills a really important mission in the research world. They place priority not only on rigorous research, but also on application of research findings.”

Greg Arling, Ph.D., a professor of nursing at Purdue University in Indiana, focuses his research on projects that aim to promote high-quality nursing home care. With AHRQ funding, Dr. Arling has studied State-level nursing home quality improvement (QI) programs to understand what makes them effective and he has facilitated dissemination of that knowledge to other States.

In 2006, Minnesota created the Performance-based Incentive Payment Program (PIPP), a nursing home QI program that provided direct up-front funding for provider-initiated quality improvement programs that were designed locally by nursing homes to meet the needs of their residents. Projects were selected by a panel of experts. Facilities had to achieve measurable outcomes, or otherwise lose part of project funding. Dr. Arling and his team used AHRQ funding to evaluate the PIPP program, identified factors that led to success of facility QI efforts, and determined PIPP’s benefits to payers and residents.

As they studied this project, Dr. Arling and his team began to notice that there were nursing home residents who had expressed a preference to return to the community, appeared healthy enough to do so, and yet remained in the nursing home. His team then developed a statistical model to identify nursing home residents whose health conditions made them good candidates for transitioning back to the community. This research contributed to the design of the Minnesota Return to the Community Initiative (RTCI). The RTCI helps short-term, private-pay nursing home residents with improved health return to the community so that they can live more independently at home or with a relative.

Additional funding from AHRQ enabled Dr. Arling to evaluate the effectiveness of the RTCI in facilitating community discharges and achieving Medicaid savings. His team found that 60 percent of the individuals assisted by the RTCI were still living in the community after one year. What’s more, their mortality rate was lower than comparable individuals who left the nursing home without RTCI assistance. Only 8 percent of those assisted by the RTCI had converted to Medicaid over the one-year period. The RTCI’s estimated annual Medicaid cost savings was $4.1 Million.

Dr. Arling has disseminated his research findings to Medicaid programs in other States as well as to aging and disability resource centers and nursing facilities. This includes hosting a conference on nursing home value-based reimbursement with funding he received from AHRQ. During that event, researchers shared their findings on how to measure and incentivize better quality of care. State policy makers shared information about program design and engaging nursing homes in quality improvement. Findings from the PIPP program evaluation figured prominently in the discussions. “We had both academic people and State people, [and] we had a fair number of States represented,” said Dr. Arling. “They learned from each other by passing ideas back and forth,” he continued.

A research associate in the Center on Aging and the Life Course at Purdue University, Dr. Arling is a member of AcademyHealth, the American Public Health Association, and a fellow at the Gerontological Society of America. He is also a member of the editorial board for the Journal of Aging and Social Policy, and has been a member of AHRQ’s Healthcare System and Value Research Study Section.

Principal Investigator: Greg Arling, Ph.D.
Institution: Purdue University
Grantee Since: 2010
Type of Grant: Various