Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents

Abstract

Objective: To evaluate Minnesota's Return to Community Initiative's (RTCI) impact on community discharges from nursing homes.

Data sources: Secondary data were from the Minimum Data Set and RTCI staff (April 2014 - December 2016). The sample consisted of 18 444 non-Medicaid nursing home admissions in Minnesota remaining for at least 45 days, with high predicted probability of community discharge.

Study design: The RTCI facilitates community discharge for non-Medicaid nursing home residents by assisting with discharge planning, transitioning to the community, and postdischarge follow-up. A key evaluation question is how many of those transitions were directly attributable to the program. Return to Community Initiative was implemented statewide without a control group. Program impact was measured using regression discontinuity, a quasi-experimental design approach that leverages the programs targeting model.

Principal findings: Return to Community Initiative increased community discharge rates by an estimated 11 percent (P < 0.05) for the targeted population. The program effect was robust to time and increased with level of facility participation in RTCI.

Conclusions: The RTCI had a modest yet significant impact on the community discharge rates for its targeted population. Findings have been applied in strengthening the RTCI's targeting approach and transitioning process.

Keywords: nursing home to community transitions; program evaluation; regression discontinuity.

Figure 1

Validating regression discontinuity design—probability treatment increases above cut point

Figure 2

Small jump in probability of community discharge above cut point

Figure 3

Jump in probability of community discharge for facilities who discharge a relatively high number of eligible residents through program