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

Abstract

To evaluate Minnesota's Return to Community Initiative's (RTCI) impact on community discharges from nursing homes. Secondary data were from the Minimum Data Set and RTCI staff (April 2014 - December 2016). The sample consisted of 18444 non-Medicaid nursing home admissions in Minnesota remaining for at least 45days, with high predicted probability of community discharge. 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. 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. 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.