Consumer-Reported Quality Indicators for Publicly-Funded Home and Community-Based Services: Development and Validation

BACKGROUND AND OBJECTIVES: Consumer-reported measures are important quality indicators for assuring person-centeredness in home and community-based services (HCBS). However, administrative data commonly used to assess HCBS quality often lacks consumer-reported measures. The National Core Indicators-Aging and Disability (NCI-AD) Adult Consumer Survey (ACS) presents an opportunity to address this gap. We analyzed data from the NCI-AD ACS to develop and validate novel consumer-reported quality indicators for older adult consumers of publicly funded HCBS. RESEARCH DESIGN AND METHODS: We applied exploratory factor analyses to data from the 2018-2019 survey wave (n = 5,572 community-dwelling older consumers, age ≥65 years) and identified seven QIs. We confirmed the validity of these seven new QIs in two ways: (1) qualitatively through a technical expert panel (for face validity and contextualization) and (2) quantitatively, using confirmatory factor analyses in the 2017-2018 survey wave (n = 9,145 community-dwelling consumers, age ≥65 years). RESULTS: The seven newly developed and validated QIs included service satisfaction (3 survey items, Cronbach's alpha = 0.89, McDonald's omega = 0.90), staff quality (5 survey items, alpha = 0.86, omega = 0.89), environmental safety (4 survey items, alpha = 0.81, omega = 0.89), service decision-making (5 survey items, alpha = 0.79, omega = 0.86), daily life decision-making (5 survey items, alpha = 0.73, omega = 0.81), community inclusion (5 survey items, alpha = 0.78, omega = 0.86), and overall health and quality of life (4 survey items, alpha = 0.63, omega = 0.70). In exploratory descriptive analyses, for some domains we found differences in scores by dementia status and age. DISCUSSION AND IMPLICATIONS: These seven new consumer-reported quality indicators can be used by researchers, service providers, and policy makers for evaluating and monitoring service quality and identifying modifiable targets for quality improvement in publicly funded HCBS.