Person-Centered Care Adoption through PEAK 2.0 Improves Clinical Quality and Resident Satisfaction

Person-Centered Care Adoption through PEAK 2.0 Improves Clinical Quality and Resident Satisfaction
By, Laci Cornelison, MS, LBSW, ACHA Migette Kaup, PhD., Gayle Doll, PhD.

Executive Summary
Kansas State University’s Center on Aging and Leading Age National partnered to research the clinical and resident satisfaction outcomes of the Kansas PEAK 2.0 program through a project funded by the Retirement Research Foundation. Analysis of clinical and resident satisfaction measures demonstrate a strong correlation with the level of person-centered care (PCC) adoption of homes in the PEAK 2.0 program. Outcomes are most significant for homes that have implemented comprehensive PCC practices (level 3-5 homes), and sustaining these changes are key to quality improvements in both health and satisfaction of residents who reside in PEAK participant homes.

An analysis of the data reveals that the PEAK 2.0 program creates a significant impact on the health and satisfaction of residents who reside in PEAK participant homes. These results demonstrate that Kansas has implemented one of the most effective and impactful pay-for-performance programs in the US.

Resident Satisfaction
One of the major goals of PCC is improving resident quality of life, so naturally the long-term care community of stakeholders are quite interested in how the adoption of PCC effects resident quality of life. Though there are no direct, readily available measures for quality of life; KDADS initiated the My InnerView resident satisfaction survey that was conducted in 81% of Kansas nursing homes. Within this tool, residents were surveyed about quality of life, quality of care, and quality of service. This is the data we used for this study.

Key study findings

1. The results show that homes in the PEAK 2.0 program have higher satisfaction ratings than non-participating homes.
2. As homes progress through the PEAK 2.0 levels, satisfaction across many dimensions of life rises.
3. Full implementation of person-centered care (level 3-5 homes) results in significantly higher resident satisfaction in quality of life and quality of care. This demonstrates that full, comprehensive adoption of person-centered care has the greatest impact and value for residents in terms of satisfaction in quality of life and quality of care.

Note: The study did control for confounding variables (such as ownership status, Medicaid rates, resident acuity level, etc.) through propensity scoring. Our thanks to Dr, Linda Hermer for her statistical expertise in performing this these analyses.

Clinical Quality Measures
While evaluating specific clinical practices is not an objective of the PEAK 2.0 program, it is important to know how quality of care may be impacted as PCC is adopted. To study clinical outcomes the researchers used publicly available MDS data. All quality measure indicators were studied.

Key study findings:

• Major depressive symptoms declined by 42% from stage 0 (non-participants) to stage 4 (levels 3-5). Declines in major depressive symptoms start as early as the foundation level of the program.
• Low-risk residents with pressure ulcers declined by 38% from stage 0 (no-participants) to stage 4 (levels 3-5). Declines in low-risk residents with pressure ulcers start as early as the foundation level of the program.
• Residents with an in-dwelling catheter declined by 34% from stage 0 (non-participants) to stage 4 (levels 3-5).
• Residents with urinary tract infections declined significantly. The largest decline was seen between stage 0 (non-participants) and stage 3 (level 2).
• Low risk residents with an incontinent episode showed a significant decline in the early stages of the program (foundation- level 2) but not at stage 4 (levels 3-5).
• Residents on antipsychotics showed a significant decline from stage 0 (non-participants) to stage 3 (level 2). No other levels of the program showed significant changes as compared to non-participating homes. This measure was the most difficult to interpret and remains ambiguous.
• Residents reporting moderate to severe pain increase mildly from stage 0 (non-participants) and stage 1 (foundation) and stage 2 (level 1). There were no significant changes in the upper level homes.

Note: The study did control for confounding variables (such as ownership status, Medicaid rates, resident acuity level, etc.) through propensity scoring. Our thanks to Dr, Linda Hermer for her statistical expertise in performing this these analyses.

Conclusions
Participating in the PEAK 2.0 program is a multi-layered, multi-step process for homes that requires dedication to re-evaluating how long-term care is delivered by staff and experienced by residents.  This is not an easy or quick undertaking. The results provided through these analyses, however, demonstrate that the commitment is worth the effort.

Outcomes appear to be most significant for homes that have implemented comprehensive PCC practices, and sustaining these changes are key to quality improvements in both health and satisfaction of residents who reside in PEAK participant homes.

Most pay-for-performance programs lead to few significant improvements, and those that do show such results improve by only a few percentage points. In contrast, participating in PEAK often results in improvements in clinical and satisfaction measures of 10% – 40%, demonstrating that Kansas has implemented one of the most effective and impactful pay-for-performance programs in the US.

This study is a first look at the outcomes of PCC adoption in Kansas nursing homes through the PEAK 2.0 program. Further studies that look at longitudinal trends as well as further investigation of quality of life specifically are important to continue to gain insight into the effects of PCC implementation.