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Archived: This report is greater than 3 years old. Findings may be used for research purposes, but should not be considered current.
This report is from AHRQ's series on Future Research Needs Projects.
Structured Abstract
Objectives
To identify gaps in the current research on long-term care (LTC) for older adults that limited the conclusions of the comparative effectiveness review (CER) “Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care” in order to inform those who conduct and fund research about the research needs on this topic.
Methods
We used a deliberative process to identify specific research needs and research design considerations. We refined a list of evidence gaps from the CER and recruited a diverse stakeholder panel to supplement this list of gaps. Based on stakeholder feedback about the current policy environment and consumer preference for home and community-based services (HCBS), we developed two sets of research questions and separated each set into methodological questions and topical questions. The first set addressed the topic of the CER, which was the comparison of LTC for older adults delivered through HCBS and in nursing homes (NHs). The second set addressed broader LTC issues that stakeholders raised as salient for the current policy environment; this set framed questions about these settings and services separately rather than as a comparison. We sent both sets of research questions to stakeholders to rank by priority, and we calculated unweighted and weighted scores based on their rankings. We identified breakpoints in the weighted rankings that separated high- and moderate-/low-priority research questions. Highly prioritized research questions were considered research needs. We discussed research design considerations for research needs.
Results
Of 13 stakeholders invited to participate, 10 completed the ranking exercise. Among the methodological questions for the comparison of LTC delivered through HCBS and in NHs, the identification of standardized outcome measures for HCBS and NHs recipients was the highest priority. For the broader set of methodological questions about LTC through HCBS and in NHs, the highest rankings were given to four questions related to outcome measures and descriptions of the interventions. For the topical questions for the comparison of LTC delivered through HCBS and in NHs, the highest rankings were given to questions related to the pattern of transitions for LTC uses, and the factors leading to transitions. We also identified four high-priority topical questions primarily related to the populations that benefit most from interventions and the types of interventions that lead to improved outcomes. Future studies on LTC for older adults should aim to reduce bias as much as possible through research design and statistical techniques. Larger sample sizes will allow more research on subpopulations, and longer followup times will allow a better understanding of how interventions may modify outcomes over time.
Conclusions
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 deemed important within the current policy environment. Future research in this area will create a broader and stronger evidence base for making care and policy decisions.
