Environmental Scan Research Articles

A Framework for Developing Health Equity Initiatives in Radiology

PurposeIn recent years, radiology departments have increasingly recognized the extent of health care disparities related to imaging and image-guided interventions. The goal of this article is to provide a framework for developing a health equity initiative in radiology and to articulate key defining factors. MethodsThis article leverages the experience of three academic radiology departments and explores key principles that emerged when observing the experiences of these departments that have begun to engage in health equity–focused work. ResultsA four-component framework is described for a health equity initiative in radiology consisting of (1) environmental scan and blueprint, (2) design and implementation, (3) initiative evaluation, and (4) community engagement. Key facilitators include a comprehensive environmental scan, early stakeholder engagement and consensus building, implementation science design thinking, and multitiered community engagement. ConclusionsAll radiology organizations should strive to develop, pilot, and evaluate novel initiatives that promote equitable access to high-quality imaging services. Establishing systems for high-quality data collection is critical to success. An implementation science approach provides a robust framework for developing and testing novel health equity initiatives in radiology. Community engagement is critical at all stages of the health equity initiative time line.

Quality Measurement Gaps in Pediatric-To-Adult Health Care Transition in the United States: A Framework to Guide Development of New Measures

PurposePediatric-to-adult health care transition (HCT) is a critical component of care for youth and young adults (Y/YA), especially those with chronic conditions. Positive outcomes in population health, patient experience, and utilization of care for Y/YA with chronic conditions have been associated with a structured HCT approach. Despite these outcomes and professional recommendations, few Y/YA receive HCT guidance from providers. Compounding this problem is the lack of attention to HCT quality measurement to stimulate and evaluate practice improvements and ensure accountability in pediatric and adult care. MethodsA multistep process was undertaken to develop a new HCT quality measurement framework and identify existing HCT measures from national databases. Based on an environmental scan, the framework was created, measure gaps identified, and measure concepts proposed to fill these gaps. A multistakeholder advisory committee provided guidance throughout this initiative. ResultsThe HCT measurement framework has 11 domains: one structure domain (health organization characteristics), three process domains (clinician HCT activities, Y/YA/F activities, continuity of care), four outcome domains (population health, utilization/cost/value of care, patient experience, and clinician experience), and three mediator domains (Y/YA/F-centered care, care coordination, and Y/YA/F characteristics). The search yielded 49 potentially relevant measures but only four qualified as directly relevant to HCT. Fifty four HCT measure concepts were proposed to address these shortcomings. DiscussionPediatric-to-adult HCT quality measurement is largely absent in nationally recognized databases. This article provides a comprehensive HCT quality measurement framework, which was used to identify gaps and propose measure concepts as a roadmap for future HCT quality measurement improvements.

Specialized Clinics and Health Care Professional Resources for Post–COVID-19 Condition in Canada


 This Environmental Scan aims to provide an overview of the current range and scope of both specialty clinics and available resources for health care professionals about post–COVID-19 condition in Canada. This scan was informed through a limited literature search and a survey completed by targeted contacts across Canada.
 Based on the survey responses, specialized clinics for post–COVID-19 condition have been established or are in development in Alberta, British Columbia, New Brunswick, Ontario, and Quebec. These clinics exist in various forms and range in their structural characteristics, operational characteristics, and stage of program development and quality improvement activities.
 At the time the survey was administered, there were no specialized clinics located in Manitoba, Newfoundland and Labrador, Northwest Territories, Prince Edward Island, Saskatchewan, and Yukon. These jurisdictions are at various stages in their approach to addressing post–COVID-19 condition, ranging from prevention efforts to the discussion of and planning for the implementation of clinics in their own jurisdiction.
 Based on the results of the literature search, there are a variety of resources that have been developed to improve the education, awareness, and training of health care professionals about post–COVID-19 condition. Referral pathways, tools for symptom screening and patient management, and educational resources, such as webinars, are among the most common. Resources about the development of clinics or models of care for post–COVID-19 condition have also been created.
 There is a gap in the jurisdictional representation from some provinces and territories for specialty clinics for post–COVID-19 condition. In addition, this Environmental Scan is not exhaustive and does not necessarily capture all existing clinics in each jurisdiction nor does it provide a comprehensive list of all available resources for health care professionals.

"Healthy Kids"-A capacity building approach for the early childhood education and care sector.

Queensland children have a higher level of developmental vulnerability compared to the Australian average. This paper reports on Healthy Kids-a capacity building strategy for the early childhood education and care (ECEC) sector targeting communities experiencing socio-economic and child development vulnerabilities. These communities may face additional barriers when engaging and participating in health promotion models. This paper reports on the development, key components and principles of a capacity building model referred to as Healthy Kids, that strategically responds to these barriers and supports these communities. The development of the Healthy Kids model emerged through a quality improvement process that included an environmental scan, and review of existing capacity building, health promotion, and workforce development approaches. It also involved consultation and engagement with the ECEC sector. Evidence indicates Healthy Kids to be an innovative health promotion model focussed on building capacity through a workforce development strategy for the ECEC sector in a way that is accessible, low cost, and sustainable. SO WHAT?: This paper shares a model for building capacity through the establishment of localised cross-sector communities of practice across a large geographic region with a centralised coordinating hub. The hub and spoke model has facilitated community ownership to grow and be sustained over time. This model offers opportunities for partnerships, transferability, and contextualisation for those interested in contemporary health promotion, capacity building, and workforce development. The model offers an approach for those willing to step outside traditional boundaries to work across sectors and settings to achieve sustainable knowledge and skills, processes and resources that enables a collective commitment to improving health outcomes.

Feasibility and acceptability of self-collection of Human Papillomavirus samples for primary cervical cancer screening on the Caribbean Coast of Nicaragua: A mixed-methods study.

Cervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO's call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study. Between 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples. Over the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate. Self-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control.

Promoting patient engagement in cancer genomics research programs: An environmental scan.

Background: A national priority in the United States is to promote patient engagement in cancer genomics research, especially among diverse and understudied populations. Several cancer genomics research programs have emerged to accomplish this priority, yet questions remain about the meaning and methods of patient engagement. This study explored how cancer genomics research programs define engagement and what strategies they use to engage patients across stages in the conduct of research. Methods: An environmental scan was conducted of cancer genomics research programs focused on patient engagement. Research programs were identified and characterized using materials identified from publicly available sources (e.g., websites), a targeted literature review, and interviews with key informants. Descriptive information about the programs and their definitions of engagement, were synthesized using thematic analysis. The engagement strategies were synthesized and mapped to different stages in the conduct of research, including recruitment, consent, data collection, sharing results, and retention. Results: Ten research programs were identified, examples of which include the Cancer Moonshot Biobank, the MyPART Network, NCI-CONNECT, and the Participant Engagement and Cancer Genome Sequencing (PE-CGS) Network. All programs aimed to include understudied or underrepresented populations. Based on publicly available information, four programs explicitly defined engagement. These definitions similarly characterized engagement as being interpersonal, reciprocal, and continuous. Five general strategies of engagement were identified across the programs: 1) digital (such as websites) and 2) non-digital communications (such as radio broadcasts, or printed brochures); 3) partnering with community organizations; 4) providing incentives; and 5) affiliating with non-academic medical centers. Digital communications were the only strategy used across all stages of the conduct of research. Programs tailored these strategies to their study goals, including overcoming barriers to research participation among diverse populations. Conclusion: Programs studying cancer genomics are deeply committed to increasing research participation among diverse populations through patient engagement. Yet, the field needs to reach a consensus on the meaning of patient engagement, develop a taxonomy of patient engagement measures in cancer genomics research, and identify optimal strategies to engage patients in cancer genomics. Addressing these needs could enable patient engagement to fulfill its potential and accelerate the pace of cancer genomic discoveries.

The Use of Evidence Synthesis in the Context of Healthcare: A Literature Review Primer

Introduction: Evidence synthesis (ES) uses different systematic methodologies to compile a body of evidence on a given topic based on existing literature to help inform practice, policy, and future research decisions. There are multiple ways to categorize different types of ES. However, they differ in how they search, appraise, synthesize, and analyze data. Some of the most common ES forms include systematic, narrative, scoping, critical, environmental scans, and rapid reviews. Utility: ES offers a myriad of benefits. These methodologies provide an immediate response to a question using research that has already been approved, funded, and completed, highlighting potential applications in numerous non-research-focused disciplines. Additionally, when information is not readily available in the current literature, ES methodologies elucidate gaps in knowledge that otherwise would be masked. Finally, they enhance the development of novel strategies, studies, and theories by summarizing, appraising, and critiquing current literature despite not being a direct source of unknown information. Challenges: Several practical challenges inhibit the use of ES. To compile any form of ES, access to a wide range of databases and peer-reviewed journals is necessary, thus hindering feasibility for non-academic researchers and those in poorly funded research organizations. These challenges are often exacerbated in developing countries. Due to these barriers, ethical implications exist regarding the lack of inclusive evidence-building between scientists. Additionally, conducting a rigorous and rigid systematic review that analyzes every significant paper on a particular topic is highly time-consuming, thus hampering the effective utilization of ES in most labs. Limitations: ES techniques contain several inherent limitations. Firstly, research questions that are too specific such that existing literature is inadequate or questions that are too broad, such that existing literature is in excess, make ES methodologies weak in providing accurate answers. Additionally, to achieve objectivity, authors of ES studies need to create comprehensive inclusion/exclusion criteria. Unfortunately, this often fosters bias amongst different interpretations of the criteria, thus influencing what research gets included in the analysis. Subsequently, the validity of the entire ES method is jeopardized.

North American Weight Management Programs for People Living With Chronic Kidney Disease: An Environmental Scan

Background: The availability and accessibility of patient-centered weight management programs is critical to mitigate the increasing prevalence of obesity in people living with chronic kidney disease (CKD). Little is known about the availability of contemporary programs that can safely and effectively support individuals living with obesity and CKD across North America. Objective: We sought to identify weight management programs specific to those with CKD and explore their safety, affordability, and adaptability to this patient population. We also identified the barriers and facilitators of identified programming including their accessibility to real-world patients (eg, cost, access, support, and time). Design: Environmental scan of weight management programs. Setting: North America. Patient: People living with CKD. Methods: We identified weight management programs and associated barriers and facilitators, via an Internet-based search of commercial, community-based, and medically supervised weight management programming. We also conducted a gray literature search and contacted weight management experts and program facilitators to explore strategies as well as their barriers and facilitators. Results: We identified 40 weight management programs available to people living with CKD across North America. Programs were commercial (n = 7), community-based (n = 9), and medically supervised (Canada n = 13, U.S n = 8) in origin. Three programs were specifically tailored to CKD (n = 3). In addition to formal programs, we also identified online nutritional resources and guidelines for weight loss in CKD (n = 8), and additional strategies (self-management tools, group orientated programs, moderate energy restrictions in conjunction with exercise and Orlistat) for weight loss from the gray literature (n = 3). Most common barriers were difficulty accessing some of the suggested nutritious food options due to the high cost, lack of support from family, friends and health practitioners, the time commitment required to participate, and the exclusion from weight management programs due to unique dietary needs for the CKD population. Most common facilitators were programs that were patient-centered, evidence-based, and offered both group and individual formats. Limitations: Although our search criteria were broad, it is possible that we did not capture all weight management programs available across North America. Conclusions: This environmental scan has generated a resource list of existing safe and effective programs for or adaptable to people with CKD. This information will inform future efforts to develop and deliver CKD-specific weight management programs to patients living with comorbid disease. Engaging people living with CKD to understand the acceptability of these programs, is an important focus for future research.

The NCSBN 2023 Environmental Scan: Nursing at a Crossroads—An Opportunity for Action: Nursing at a Crossroads: An Opportunity for Action

Nursing is at a crossroads. Emerging from the peak of one of the worst pandemics in history, the nursing profession is facing multiple challenges: hospitals and other facilities report a growing nurse shortage, new graduates express uncertainty about their readiness to practice, nursing education is both grappling with a faculty shortage and scrutinizing the best methods for educating students, and violence toward healthcare providers is of major concern along with stress and burnout. But with challenges come opportunities. To provide insight for regulators, nursing leaders, and policymakers on the extraordinary circumstances currently confronting nursing, the National Council of State Boards of Nursing (NCSBN) presents the embodiment of this information and data in its annual Environmental Scan.

Funding change: An environmental scan of research funders’ knowledge translation strategic plans and initiatives across 10 high-income countries/regions

Knowledge translation (KT) is the science and practice of dissemination and implementation of evidence. We describe how research funders operationalize and evaluate KT initiatives, identify challenges and opportunities, and suggest strategic considerations for KT support. We conducted an environmental scan, which included a systematic search of published and grey literature and a focus group with Canadian funders. A total of 130 published articles and 2415 grey literature sources were screened; 212 unique data sources were included. Published literature commonly described KT initiatives related to “KT practice and science funding.” These initiatives commonly provided funds for infrastructure development (e.g., clinical technologies, database subscriptions) to facilitate translational or applied research to address regional health priorities. Of the articles, 44% outlined an evaluation plan; few provided validated KT metrics. In the grey literature, 364 initiatives were described; the most commonly described initiatives related to “exchange and integrated KT.” Focus group participants hoped to see increased resources to support KT, exchange opportunities with policy/decision-makers, and evaluate KT initiatives. Funders completed various KT initiatives, which tended to engage stakeholders to set research priorities, collaborate with a range of stakeholders, build KT capacity, and mandate KT requirements. We provide six considerations for funders to support KT.

A scientometric analysis of cycling and the case study of the city of Ioannina

In urban areas, cycling as a sustainable mode of transport contributes to creating more liveable and vibrant urban environments. They take up less space than cars, reduce noise pollution, and create a human-scale, people-friendly atmosphere. This paper provides an environmental and sustainable scan of the literature on bicycles using established systematic literature review approach. The main issues the existing literature is dealing with according to the identified clusters can be categorized into four main categories that rely on environment-oriented, infrastructure-oriented, safety-oriented and health-oriented research fields, where the majority of research has been focused during the analysis period. Moreover, in this study, the implementation and use of cycling in the city of Ioannina is examined. The technical characteristics of the existing cycling paths in the city, the policy and the behavioral aspect of the people are presented by analyzing the responses of 102 residents of Ioannina in a structured questionnaire.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions.

Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy. We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations. An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018). Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery. The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Librarian Contributions to Evidence Synthesis Programs: Addressing the COVID-19 Infodemic

The purpose of this article is to examine the role of health sciences librarians in emerging evidence synthesis programs during the COVID-19 global health pandemic. This environmental scan aims to showcase a range of emergent and responsive library evidence services. The scope of contributions by health sciences librarians in evidence synthesis innovations is highlighted, along with examples illustrating how health sciences librarians helped mitigate the spread of inaccurate or incomplete COVID-19 information. New evidence services emerging in response to the COVID-19 infodemic included preparing evidence summaries, curating research on COVID-19, providing expert searching services to monitor the evolving research evidence, and helping individuals build critical appraisal skills to assess the increasing amounts of COVID-19 information. In addition, resources for locating published evidence syntheses on COVID-19 topics are provided.

Análise de particularidades da participação lusófona em uma Rede de Conhecimentos em Enfermagem

Abstract Objective To describe the conceptual exercise of reflecting on the possibilities and particularities of the participation of Lusophone schools of nursing in the Nursing Knowledge Network. Method An analysis was conducted using information obtained from an environmental scan of institutional resources following the conceptual framework by Prug and Prusak on the knowledge networks. The learnings reported in the analysis are based on the collected information and reflections on the positive and negative aspects of participation, while proposing possible solutions for an action plan. Results There is interest in the internationalization of research and collaborative work both as institutional actions to support nursing research and potential benefits due to participation in the Network. The collaborative work has potential to increase the impact of research, expedite dissemination and use of results both in education and in clinical practice, broadening the horizons of Lusophone nursing science. Conclusion and Implications for practice Participation of these institutions in the Network offers numerous possibilities to demonstrate the originality, creativity and expertise of their teaching and research practice, encouraging the sharing of ideas and practices. The practice of scientific production in all its scenarios by educators and students can be improved through refined ways of thinking, creating, producing, and disseminating knowledge.

An Equity-Based Scoring System for Evaluating Surveillance-Related Harm in Public Health Crises

BackgroundAlthough surveillance systems used to mitigate disasters serve essential public health functions, communities of color have experienced disproportionate harms (eg, criminalization) as a result of historic and enhanced surveillance.MethodsTo address this, we developed and piloted a novel, equity-based scoring system to evaluate surveillance systems regarding their potential and actual risk of adverse effects on communities made vulnerable through increased exposure to policing, detention/incarceration, deportation, and disruption of access to social services or public resources. To develop the scoring system, we reviewed the literature and surveyed an expert panel on surveillance to identify specific harms (eg, increased policing) that occur through surveillance approaches.ResultsScores were based on type of information collected (individual and/or neighborhood level) and evidence of sharing information with law enforcement. Scores were 0 (no risk of harm identified), 1 (potential for risk), 2 (evidence of risk), and U (data not publicly accessible). To pilot the scoring system, 44 surveillance systems were identified between June 2020 and October 2020 through an environmental scan of systems directly related to COVID-19 (n=21), behavioral and health-related services (n=11), and racism and racism-related factors (n=12). A score of 0-2 was assigned to 91% (n=40) of the systems; 9% were scored U; 30% (n=13) scored a 0. Half scored a 1 (n=22), indicating a “potential for the types of harm of concern in this analysis.” “Evidence of harm,” a score of 2, was found for 12% (n=5).ConclusionsThe potential for surveillance systems to compromise the health and well-being of racialized and/or vulnerable populations has been understudied. This project developed and piloted a scoring system to accomplish this equity-based imperative. The nobler pursuits of public health to improve the health for all must be reconciled with these potential harms.

Implementation of the Synergy Tool: A Potential Intervention to Relieve Health Care Worker Burnout.

(1) Background: Healthcare workers experienced rising burnout rates during and after the COVID-19 pandemic. A practice-academic collaboration between health services researchers and the surgical services program of a Canadian tertiary-care urban hospital was used to develop, implement and evaluate a potential burnout intervention, the Synergy tool. (2) Methods: Using participatory action research methods, this project involved four key phases: (I) an environmental scan and a baseline survey assessment, (II), a workshop, (III) Synergy tool implementation and (IV) a staffing plan workshop. A follow-up survey to evaluate the impact of Synergy tool use on healthcare worker burnout will be completed in 2023. (3) Results: A baseline survey assessment indicated high to severe levels of personal and work-related burnout prior to project initiation. During the project phases, there was high staff engagement with Synergy tool use to create patient care needs profiles and staffing recommendations. (4) Conclusions: As in previous research with the Synergy tool, this patient needs assessment approach is an efficient and effective way to engage direct care providers in identifying and scoring acuity and dependency needs for their specific patient populations. The Synergy tool approach to assessing patient needs holds promise as a means to engage direct care providers and to give them greater control over their practice-potentially serving as a buffer against burnout.

A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities.

In community-based research projects, needs assessments are one of the first steps to identify community priorities. Access-related issues often pose significant barriers to participation in research and evaluation for rural and remote communities, particularly Indigenous communities, which also have a complex relationship with academia due to a history of exploitation. To bridge this gap, work with Indigenous communities requires consistent and meaningful engagement. The prominence of digital devices (i.e., smartphones) offers an unparalleled opportunity for ethical and equitable engagement between researchers and communities across jurisdictions, particularly in remote communities. This paper presents a framework to guide needs assessments which embed digital platforms in partnership with Indigenous communities. Guided by this framework, a qualitative needs assessment was conducted with a subarctic Métis community in Saskatchewan, Canada. This project is governed by an Advisory Council comprised of Knowledge Keepers, Elders, and youth in the community. An environmental scan of relevant programs, three key informant interviews, and two focus groups (n = 4 in each) were conducted to systematically identify community priorities. Through discussions with the community, four priorities were identified: (1) the Coronavirus pandemic, (2) climate change impacts on the environment, (3) mental health and wellbeing, and (4) food security and sovereignty. Given the timing of the needs assessment, the community identified the Coronavirus pandemic as a key priority requiring digital initiatives. Recommendations for community-based needs assessments to conceptualize and implement digital infrastructure are put forward, with an emphasis on self-governance and data sovereignty.

MOVING FROM ENDORSEMENT TO ACTION: ALIGNING AFU EFFORTS WITH UNIVERSITY STRATEGIC PLANS AND GOALS

Abstract The Age-Friendly University global initiative has the opportunity to unite nations around the world towards making higher education spaces inclusive of older adults. Once a university joins the AFU Global Network and endorses the 10 guiding principles, the real work of living up to the principles begins. Each institution has unique geographical, political, social, and financial characteristics that require tailored approaches to this work. At our regional comprehensive university, we completed three separate analyses (external, internal, future directions) as part of our Environmental Scan. The goal of the Environmental Scan was to understand the initial strengths, weaknesses, and opportunities to age-friendliness and inclusiveness for older learners within our campus community. We utilized a multi-pronged data collection approach, including individual stakeholder interviews, online surveys of older leaners, policy analysis, and internal and external audits. Many aspects of data collection for the environmental scan occurred concurrently with data analysis. Data from each of the eight data collection methods were used to generate key findings and recommendations and will be presented. Furthermore, we found that aligning our recommendations with the University’s marketing and enrollment efforts as well as the University’s goals relating to diversity, equity and inclusion allowed for greater administrative support for strategies to increase age-friendliness on campus. with implications for similar work at other institutions. The Age-Friendly University global initiative has the opportunity to better support the inclusion of older adults in higher education. Our Environmental Scan of age-friendliness, from inception to completion will apply to institutions across the globe.

STATE USE OF VALUE-BASED PAYMENT IN NURSING FACILITIES

Abstract Some states use value-based payment (VBP) programs as part of their nursing facility Medicaid payment systems. The purpose of this study was to determine which states use these programs, their goals, the measures used and other elements of these programs. An environmental scan was conducted to identify states that have VBP programs for nursing facilities, the key design elements of those programs, and the goals that states are aiming to achieve. Interviews with seven stakeholders were also conducted. We found that 20 states and the District of Columbia use VBP for nursing facilities with the goals of improving quality and increasing efficiency. However, due to lack of evaluation, it is not known if these programs are achieving their goals. Additional research is needed to determine which state programs are most successful. The results of such research would help in the development of future VBP programs.

CAREGIVER-SPECIFIC QUALITY MEASURES FOR HCBS: STAKEHOLDER PRIORITIES AND ENVIRONMENTAL SCAN

Abstract Although informal family caregivers are increasingly recognized for their essential role in helping older and/or medically-complex adults live in the community for as long as possible, their priorities and perspectives have not been well-integrated into assessments of home- and community-based services (HCBS). Our aim was to identify measurement gaps to guide quality monitoring and improve HCBS. Caregiver concerns and quality measurement priorities were identified during a multi-level stakeholder engagement process (34 Veterans, 24 caregivers, and 39 facility leaders, clinicians, and staff) across four VA healthcare systems. We conducted an environmental scan and scoping review of national quality measure sets for HCBS, comparing caregiver-specific items against stakeholder-identified concerns and priorities. Only five of eleven non-VA measure sets and three of four VA measure sets included caregiver-specific items; these did not encompass the full range stakeholder-identified concerns and priorities. Measures that emphasize caregivers can help healthcare systems monitor and improve HCBS quality.