Objective To determine whether the Bundled Payments for Care Improvement (BPCI) initiative affected patient‐reported measures of quality. Data Sources Surveys of Medicare fee‐for‐service beneficiaries discharged from acute care hospitals participating in BPCI Model 2 and comparison hospitals between October 2014 and June 2017. Variables from Medicare administrative data and the Provider of Services file were used for sampling and risk adjustment. Study Design We estimated risk‐adjusted differences in patient‐reported measures of care experience and changes in functional status, for beneficiaries treated by BPCI and comparison hospitals. Data Collection We selected a stratified random sample of BPCI and matched comparison beneficiaries. We fielded nine waves of surveys using a mail and phone protocol, yielding 29 193 BPCI and 29 913 comparison respondents. Principal Findings Most BPCI and comparison survey respondents reported a positive care experience and high satisfaction. BPCI respondents were slightly less likely than comparison respondents to report positive care experience or high satisfaction. Despite these differences in care experience, there was no difference between BPCI and comparison respondents in self‐reported functional status approximately 90 days after hospital discharge. Conclusions These findings reduce concerns that BPCI may have unintentionally harmed patient health but suggest room for improvement in patient care experience.
Objective To describe functional goals and factors associated with goal attainment among low-income older adults with disabilities living in the community. Design Secondary analysis from two studies of CAPABLE. Functional goals were coded using the International Classification of Functioning, Disability, and Health (ICF) framework. The percentage of goals attained at five months follow-up was computed within each ICF domain. Multivariate logistic regression was used to identify factors associated with goal attainment. Setting Participants’ homes in Baltimore, Maryland Participants CAPABLE participants (n=226) Interventions A five-month, home-based, person-directed, structured program delivered by an inter-professional team: occupational therapist (OT), registered nurse (RN), and handyman. Main Outcome Measure(s) Process of OT goal setting and attainment at the final OT visit. Results Participants identified 728 functional goals (average of 3.2 per participant), most commonly related to transferring (22.0%, n=160 goals), changing or maintaining body position (21.4%, n=156 goals), and stairclimbing (13.0%, n= 95 goals). Participants attained 73.5% (n=535) of goals. Goal attainment was highest for stairclimbing (86.3%), transferring (85.6%), and self-care (84.6%); walking goals were less likely attained (54.0%). Goal attainment was not associated with age, gender, education, depressive symptoms, function, or health-related quality of life but was less likely among participants who had severe pain compared to those without pain (aOR: 0.38, 95% CI: 0.17, 0.86). When participant readiness to change (RTC) score increases by one point on the four-point scale, goal attainment was 62% more likely (aOR 1.62; 95% CI: 1.14–2.29). Conclusion Home-based collaborative goal-setting between older adults and OTs is feasible and particularly effective when individuals are ready or willing to adopt new strategies to achieve identified goals.
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