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This project aimed to support and evaluate MI Choice, a managed home- and community-based long-term care (LTC) program, through a variety of activities. Most important among these were the implementation of a well-tested in-person assessment and care planning system (the RAI-HC), development and implementation of a screening system to determine eligibility, and initiation of a computerized information system to help manage these data. In addition, the project evaluated the effects of these changes to the MI Choice program on client outcomes. MI Choice (previously the Michigan Managed Long Term Care Initiative) was developed in 1996 by the State of Michigan to allocate scarce long-term care (LTC) resources more equitably and rationally. It aimed to expand health care access for elderly and disabled persons, spark a shift from institutional to community-based care, and enable a focus on health promotion and disease prevention.
Key accomplishments of the project were:
- Development of a screening logic applied to the MDS-HC assessment tool that helps determine eligibility and predicts the most appropriate level of care for eligible enrollees. Conclusions derived from using this screen had a higher level of agreement with expert opinions than did other systems.
- The testing of a telephone screen to determine eligibility. Information collected through telephone screens was found likely to exaggerate an individual’s level of illness or disability.
- A set of outcome measures for home care. Using user groups, expert panels in two countries, and an analysis of data from four countries, 22 home care quality indicators (HCQIs) were identified.
- Evaluating the MI Choice program. Using the HCQIs, the evaluators found that there was improvement in 16 of the 22 HCQIs, while there was stability in four and decline in two.
Although the project's accomplishments were designed primarily to affect directly the provision of home- and community-based services in Michigan, these findings should be of interest to other states, payers and providers.
In fact, several tools from this project have been adopted elsewhere. During the period of this project, the assessment system (the RAI-HC system) has been adopted by eight other states (Georgia, Massachusetts, North Carolina, Rhode Island, Utah, Texas, New Jersey- Maine had already adopted a modified RAI-HC system) and the Department of Veterans Affairs. The DVA has also adopted the screening system developed in this project. Outside of the US, the RAI-HC has been adopted by Hong Kong and several Canadian provinces, and is being considered in several other nations including Switzerland.
Publications
Fries, B.E. and James, M. 2003.
Policy Brief: Identifying "appropriate" applicants
for home and community based services: The MI Choice Screening
System.
NY: Home Care Research Initiative, The Center for
Home Care Policy and Research, Visiting Nurse Service of New
York.
Project-Related Peer-Reviewed Articles
Fries, B.E., Shugarman LR. , Morris, J.N., Simon, S.E., and
James, M.A. 2002.
"A Screening System for Michigan's Home- and Community-Based
Long- Term Care Programs"
The Gerontologist, 42(4):462-474.
Shugarman, L.R., Buttar, A., Fries, B.E., Moore, T., and Blaum, C.S. 2002.
"Caregiver Attitudes and Hospitalization Risk in Michigan Residents Receiving Home- and Community-Based Care."
Journal of the American Geriatrics Society, 50(6):1079-1085.
Buttar, A., Blaum, C., and Fries, B.E. 2001.
"Clinical Characteristics and 6-Month Outcomes of Nursing Home Residents with Low Activities of Daily Living (ADL) Dependency"
Journal of Gerontology: Medical Sciences, 56A(5):M292-M297.
Bjorkgren, M.A., Fries, B.E., and Shugarman, L. 2000.
"Testing a RUG-III Based Case-Mix System for Home Health Care"
Canadian Journal of Aging, 19(Supp. 2):106-125.
Shugarman, L.R., Fries, B.E., and James, M. 1999.
"A Comparison of Home Care Clients and Nursing Home Residents: Can Community Based Care Keep the Elderly and Disabled at Home?"
Home Health Care Services Quarterly, 18(1): 25-45.
Affiliated research
(using the data collected on this study)
Frijters, D., Achterberg, W., Hirdes, J.P., Fries, B.E.,
Morris, J.N., and Steel, K. 2001.
“Integrated health information systems based on Resident
Assessment Instruments.”
Tijdschrift Voor Gerontologie En Geriatrie, 32(1),
8-16.
Hirdes, J.P., Fries, B.E., Morris, J.N., Steel, K., Mor, V., Frijters, D., LaBine, S., Schalm, C., Stones, M.J., Teare, G., Smith, T., Marhaba, M., Pérez, E., and Jónsson, P. 1999.
"Integrated Health Information Systems Based on the RAI/MDS Series of Instruments"
Healthcare Management Forum, 12(4):30-40.
Morris, J.N., Fries, B.E., Bernabei, R., Steel, K., Ikegami, N., Carpenter, G.I., Gilgen, R., DuPasquier, J., Frijters, D., Henrard, J., Hirdes, J.P., and Belleville-Taylor. 2000.
RAI-Home Care (RAI- HC) Assessment Manual for Version 2.0
Marblehead, MA: Opus Communications.
Fries, B.E., Simon, S.E., Morris, J.N., Flodstrom, C., and Bookstein, F. 2001.
"Pain in US Nursing Homes: Validating a Pain Scale for the Minimum Data Set"
The Gerontologist, 41(2):173-179.
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