Cost effective long term care of the frail elderly

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.: Cost effective long term care of the frail elderly
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.): yes
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:: Nursing Facilities, versus Community-based care vis HCBW and PACE
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.): NF facility eligibles > 55, dually eligible and Medicaid only.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.): Multi system complex disease. including dementias
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.): Maximum functionality, decrease in unecesary hospitalizations, ER utilization, adequate preventitive care, effective advanced directives.
Describe any health-related risks, side effects, or harms that you are concerned about.

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

AHRQ Priority Populations

Elderly
Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

Describe why this topic is important.: Very expensive item in state government, several models for integrated care....new innovations?
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.): Working with policy, aiming for a value-based approach.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.): yes
If yes, please explain:: Yes, high stakes in funding and outcomes. Prevent short-sighted legislative decisions.

How will an answer to your research question be used or help inform decisions for you or your group?: Evidenc-based long term care planning poor frail elderly with chronic illness.
Describe the timeframe in which an answer to your question is needed.: Yesterday. But this year would really be helpful.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.: Elderly poor, in hispanic and native American enclaves...

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate): Evidenc-based long term care planning poor frail elderly with chronic illness.

Are you making a suggestion as an individual or on behalf of an organization?: Individual

Please tell us how you heard about the Effective Health Care Program: search engine

Effective Health Care Program