Preferences For Everyday Living Inventory Research Articles

The PELI-D II Study: Development and Preliminary Validation of the Preferences for Leisure Activities Inventory (P-LAI) for Adult Day Services

ABSTRACT Objectives The current study aimed to develop and preliminarily validate an initial version of an instrument to assess the leisure activity preferences of people receiving adult day services (ADS). Methods Based on previously conducted concept mapping steps, we identified 12 clusters of preferences for leisure activities. We adopted the structure of the Preferences for Everyday Living Inventory and phrased our cluster labels as questions to develop a first draft of the Preferences for Leisure Activities Inventory (P-LAI). We conducted cognitive interviews (n = 8) to revise, preliminarily validate, and preliminarily finalize the P-LAI. Results The draft of the P-LAI included 25 questions. Based on the results of the cognitive interviews, the number of questions was reduced to 21, three questions were rephrased, and evidence to support the preliminary validity of the P-LAI based on the response processes was provided. Conclusions The P-LAI is the first instrument to assess preferences for leisure activities in the ADS environment. Clinical implications The preliminary results of the P-LAI allow ADS providers and healthcare professionals to assess the preferences for leisure activities of people who receive ADS in a structured way. Based on these results, preference-based services can be designed and planned, and the person-centered philosophy of care can be further operationalized in the ADS environment.

UTILIZING CARE PREFERENCE ASSESSMENT TO UNDERSTAND THE NEEDS OF OLDER ADULTS AT ADULT DAY SERVICES (ADS) IN TAIWAN

Abstract Understanding individuals’ preferences and honoring them throughout the care delivery process is essential for care services. When preferences are understood and honored, care recipients perceive a greater sense of autonomy, which improves their quality of life and emotional well-being. Adult Day Services (ADS), a fast-growing community service offers daytime programs for those with physical and/or cognitive impairments. In order to better understand ADS attendees’ care preferences and to help ADS staff to deliver person-centered care in Taiwan, this study adapted the Preferences for Everyday Living Inventory for ADS in Chinese (PELI-ADS-C) to assess preferences for activities and lifestyle experiences. Forty-three interviews were conducted with older adults recruited from three different ADS centers in Taiwan. The majority of participants were females (85%) with ages ranging from 67 to 93 years old. Among the 43 preference items, “do things with groups of people” and “participate in religious services or practices” were rated as most important followed by “reminisce about the past” and “exercise.” “Volunteer your time” and “gender of the staff taking care of you” were rated as least important. Participants shared that “It is not good for us to be alone.” “It is more fun for me to be with a group of people.” “I had no time to be a volunteer when I was younger. Now, I have to attend the center every day with no time to be a volunteer.” Results can be shared with ADS staff to develop care and activities that corresponded with attendees’ preferences.

Can Implementing Person-Centered Care Tools Reduce Complaints? Evidence from the Implementation of PELI in Ohio Nursing Homes

ABSTRACT Nursing homes receive complaints when actual care provided to residents misaligns with desired care, suggesting that person-centered care (PCC) and honoring resident preferences in care delivery may help prevent complaints from arising. We explore whether nursing home implementation of a PCC tool, the Preferences for Everyday Living Inventory (PELI), is related to measures of complaints. Publicly available data on Ohio nursing homes was used to examine 1,339 nursing home-year observations. Regression techniques were used to evaluate the relationship between the extent of PELI implementation and four complaint outcomes: any complaint, number of complaints, any substantiated complaint, and number of substantiated complaints. Nursing homes with complete PELI implementation were less likely to have any complaints by 4.7% points (P < .05) and any substantiated complaints by 11.5% points (P < .001) as compared to partial PELI implementers. When complete PELI implementers did have complaints, they were fewer than partial PELI implementers. Complete PELI implementers were not immune from receiving complaints; however, the complaints they did receive were fewer in number and less likely to be substantiated as compared to communities who only partially implemented a PCC tool.

Exploring the Relationship Between Extent of Person-Centered Care Implementation and Staffing Levels in Ohio Nursing Homes.

Background: The Preferences for Everyday Living Inventory (PELI) is a person-centered care (PCC) tool that uncovers/honors older adults' important preferences. PCC implementation in nursing homes (NHs) often requires additional resources, such as staff time. We explored if PELI implementation is associated with NH staffing levels. Methods: Using NH-year as the unit of observation (n = 1307), 2015 and 2017 data from Ohio NHs was used to examine the relationship between complete versus partial PELI implementation and staffing levels, measured in hours per resident day, for various positions and total nursing staff. Results: Complete PELI implementation was associated with higher nursing staff levels in both for-profits and not-for-profits; however, total nursing staff levels in not-for-profits were higher than for-profits (0.16 vs. 0.09hours per resident day). The specific nursing staff associated with PELI implementation varied by ownership. Discussion: For NHs to fully implement PCC, a multifaceted approach to improve staffing is needed.

Translation and Cultural Adaptation of the Preferences for Everyday Living Inventory for Korean Nursing Home Settings

Valid and reliable measures are necessary to provide person-centered care. However, there are no such measures in Korean nursing home (NH) settings. The purpose of the current study was to translate and culturally adapt the Preferences for Everyday Living Inventory (PELI) into Korean following the International Society for Pharmacoeconomics and Outcomes Research guidelines. Face validity was assessed by cognitively capable Korean older adults (N = 10) using a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree). Mean score was 2.7 (SD = 0.82) for grammar and wording; 3.7 (SD = 0.48) for understandability; and 3.7 (SD = 0.67) for cultural relevance. Participants found the Korean version of the PELI (PELI-K) easy to understand and interpret, and culturally relevant. Results suggest that the PELI was successfully translated and culturally adapted to Korean. Implementing the PELI-K in Korean NHs and incorporating individual preferences into care delivery will improve quality of care. [Journal of Gerontological Nursing, 49(5), 5-10.].

Organizational and Resident Characteristics of Nursing Homes Associated With Partial and Complete Implementation of the Preferences for Everyday Living Inventory.

Person-centered care practices are essential to providing high-quality care for nursing home (NH) residents. A key component of implementing person-centered care is the assessment and fulfillment of residents' preferences. However, few NHs consistently assess and implement residents' preferences into care. From 2015 to 2019, the Ohio Department of Medicaid added the Preference for Everyday Living Inventory (PELI), a scientifically validated tool to assess residents' preferences, as a quality indicator to improve the person centeredness of Ohio's NHs. In this study, we sought to identify the associations between resident and organizational characteristics and PELI implementation in Ohio NHs. We constructed an NH-level database that merged data from the Ohio Biennial Survey of Long-Term Care Facilities, Ohio Medicaid Cost Reports, the Certification and Survey Provider Enhanced Reports data, the WWAMI Rural Health Research Center, and the Minimum Data Set. Freestanding NHs were included if they were owned by a for-profit or not-for-profit organization, and had data collected in 1 of 2 years (n = 1,320; year 2015, n = 814; year 2017, n = 506). Descriptive statistics and multiple logistic regression were used to understand the relationships between resident demographics, NH organizational characteristics, and partial versus complete PELI implementation. Most NHs (71.2%) reported complete implementation of the PELI over 2 years with implementation increasing over time. There was a relationship between complete PELI implementation and for-profit status, higher number of beds, higher Medicare funding, higher certified nursing assistants and activity staff hours, and urban location. This work has important implications for the implementation of person-centered care interventions in NHs and our understanding of what NH characteristics are related to successful implementation. The next steps should include a continued, detailed assessment of PELI implementation and an exploration of the potential impact of PELI implementation on residents, staff, and organizational outcomes.

Impact of Implementing the Preferences for Everyday Living Inventory on Nursing Home Survey Deficiencies.

The purpose of this study is to expand on previous work testing the relationship between person-centered care (PCC) and quality outcomes in the nursing home (NH) setting. We explore if the Preferences for Everyday Living Inventory (PELI) implementation is a predictor of NH quality, as defined by deficiencies. Secondary data analysis of repeated cross-sections. Data from 6 sources on Ohio NHs were merged to examine 1300 NH-year observations. Logistic regression techniques were used to evaluate the relationship between PELI implementation and 3 survey deficiency outcomes: whether the NH had a 4- or 5- deficiency star rating, deficiency score, and whether the NH had a deficiency score of0. NHs with complete PELI implementation increased the probability of having a 4- or 5- deficiency star rating by 6 percentage points (P= .039). Results also show complete PELI implementation is related to lower deficiency scores and an increased probability of having a deficiency score of 0, but only a 0 deficiency score was marginally significant. The findings indicate PCC stands to improve quality outcomes; however, benefits take time to show. Future research should seek to help improve NHs level of commitment to PCC and buy-in from policymakers.

TRANSLATION AND CULTURAL ADAPTATION OF THE PREFERENCES FOR EVERYDAY LIVING INVENTORY INTO KOREAN

Abstract Valid and reliable measures are necessary to provide person-centered care tailored to the individual. However, there are no such measures in Korean nursing home settings. Therefore, the purpose of this study was to translate and culturally adapt the Preferences for Everyday Living Inventory (PELI); test face validity; and finalize a Korean version of PELI (PELI-K). The translation and cultural adaptation were done according to guidelines of the International Society for Pharmacoeconomics and Outcomes. After translating, cognitively capable Korean older adults (n=10) reviewed the PELI items and completed a questionnaire. Face validity was assessed by three questions regarding grammar and wording, understandability, and cultural relevance using a 4-point Likert scale: 1 (strongly disagree) to 4 (strongly agree). Higher scores indicate better validity. The mean (±SD) age of participants was 67 (±2.50) years. The mean score of appropriateness for grammar and wording was 2.70 (±.82); understandability was 3.70 (±.48); and cultural relevance was 3.70 (±.67). Participants found the Korean version of PELI easy to understand and interpret, and culturally relevant. However, some translations have room for improvement in rephrasing sentences and using alternative wording. Based on cognitive debriefing results and several suggestions from participants, necessary changes were made before creating a final version of PELI-K. These findings suggest that PELI was successfully translated and culturally adapted to Korean. Implementing PELI-K in Korean nursing home settings will help with eliciting individual preferences and incorporating them into care delivery. Next steps can evaluate care quality improvement and increased residents’ satisfaction.

IT’S A COOL LITTLE TOOL: PROVIDER PERSPECTIVES ON IMPLEMENTING PAL CARDS DURING COVID-19

Abstract This symposium describes the implementation of a person-centered care (PCC) communication tool in nursing homes. PCC is a philosophy that recognizes “knowing the person” and honoring individual preferences. The communication tool is based on an assessment of NH resident likes and dislikes via the Preferences for Everyday Living Inventory (PELI). The PELI is an evidenced-based, validated instrument that can be used to enhance the delivery of PCC. The Preferences for Activity and Leisure (PAL) Card was developed to communicate important resident preferences across care team members. From July 2020 to July 2021 we lead a Quality Improvement Project (QIP) approved by the Ohio Department of Aging providing virtual coaching to providers who created 15-20 PAL Cards for their residents. Our first presentation describes the QIP where n=16 started implementation and n=11 communities completed the project during the height of the pandemic. Providers were non-profit (50%) with an average star rating of 3.29 (SD 1.33). Feedback from n=68 direct care staff on PAL Card usage are reported. The next four presentations describe implementation of PAL Cards from the perspective of the provider champions who contributed to n=66 monthly interviews. Interviews were recorded, transcribed verbatim, and coded in Dedoose using the Consolidated Framework for Implementation Research as an a priori coding scheme. We present barriers and facilitators related to the domains of Inner Setting, Characteristics of the Individual, Characteristics of the Intervention, and Process. The Discussant, Dr. Natalie Douglas will discuss the implications of initiatives to address the quality of resident care.

ASSESSING PREFERENCES FOR COMMUNICATING WITH TECHNOLOGY: A PERSON-CENTERED APPROACH TO CARE MANAGEMENT

Abstract Technological advances, such as telehealth, have been used to manage the multiple chronic conditions that impact over 25% of the US adult population. Technology-assisted communication (TAC) can help to bridge the gap in effective management of health conditions in the community by patients, informal caregivers, and healthcare providers, while emphasizing person-centered care. The purpose of this project was to develop a new theoretically-derived and evidence based subscale for the Preferences for Everyday Living Inventory (PELI) that addresses preferred TAC approaches for community-dwelling adults over the age of 50 years in the context of multiple chronic conditions (N=297). Results indicated that over 60% of older adults are satisfied with technology-based healthcare communications. In general, older adults in the sample are satisfied with all domains of technology-assisted communication that are asked within P-TAC, including timing, sending and receiving of information, and content of communications. Almost 80% (N=234) indicate that they are satisfied with the content of TAC. This research has lead to the development of assessment items that will allow providers to better assess and then integrate patient preferences for technology communication strategies into plans of care. Potential benefits of understanding preferences for TAC include alignment of chronic care management with preferred strategies which may lead to improvement care congruence and improved healthcare outcomes for the older adult.

EXPLORATORY STRUCTURAL PROCEDURES IN HEALTH SERVICES RESEARCH

Abstract When analysing data where little knowledge of relationships is available, exploratory structuring techniques, e.g., clustering and scaling techniques, are applied, using an inductive approach to construct analogies and thus suggest how to organize the data. These procedures in Health Service Research mainly focus on latent variables and are particularly used in the development of instruments or theories. Our symposium includes three presentations on research studies in which exploratory structural procedures were used for data analysis, that were considered appropriate for Health Service Research. Dr. Johannes Bergmann will present a concept mapping technique of the German Preferences for Everyday Living Inventory (PELI-D), for structuring the questionnaire from the perspective of professional nurses. This is a mixed methods participatory approach that combines interpretation and decisions by the researchers with a sequence of multivariate statistical analyses (multidimensional scaling, cluster analysis).. Jan Dreyer will present a Multiple Correspondence Analysis and Hierarchical Cluster Analysis as exploratory data reduction procedures. His aim was to identify types of home-based care arrangements for people living with dementia. To analyse the relationships between care arrangement variables, he performed Multiple Correspondence Analysis. To cluster the care arrangements, he performed Hierarchical Cluster Analysis. Anna Louisa Hoffmann will present an alternative, modified procedure of Multiple Correspondence analysis. Since Multiple Correspondence Analysis underestimates the true quality of data representation, she used Adjusted Multiple Correspondence Analysis to explore construct validity of the Dementia Policy Questionnaire (DemPol-Q). This procedure was considered appropriate to assign categorical variables to latent variables.

Projection of Care Partners’ Preferences in the Proxy Assessments of Everyday Preferences for Persons With Cognitive Impairment

Bias in surrogate decision-making can occur when proxy decision-makers overestimate the degree to which their preferences are shared by others, resulting in a projection of their beliefs onto others. The purpose of this study is to assess projection of care partners' preferences onto surrogate assessments of everyday preferences for persons with cognitive impairment (CI) and to address clinical and demographic factors as predictors of projection. The sample included 116 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. The Preferences for Everyday Living Inventory (PELI) was used to assess importance of preferences among persons with CI. Care partners completed two separate PELI assessments: one from the perspective of the persons with CI (i.e., acting as a surrogate decision-maker) and one from their own perspective. To assess for projection of care partners' preferences onto surrogate assessments of preferences for persons with CI, two-step regression with multivariable-adjusted general linear models was used. Significant projection was noted within the PELI domains of autonomous choice, personal growth, and keeping a routine (p < 0.005). More significant cognitive impairment was associated with increased projection within the PELI domains of autonomous choice and personal growth (p < 0.05). The results of this study suggest that projection of care partners' own preferences may be a significant source of bias in proxy decision-making regarding everyday preferences for persons with CI, particularly for those with more significant CI.

Projection in Proxy Assessments of Everyday Preferences for Persons with Cognitive Impairment

AbstractBackgroundA source of bias in surrogate decision‐making has been articulated alternatively as the false consensus effect, assumed similarity, and attributive/social projection by which proxies overestimate the degree that their values and preferences are shared by others, resulting in a projection of their own beliefs onto others in the process of surrogate decision‐making. The aims of this study are to assess for projection of proxies’ preferences onto surrogate assessments of everyday preferences for persons with cognitive impairment (CI) and to address cognitive and neuropsychiatric symptom burden as predictors of projection.MethodThe sample included 116 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. The Preferences for Everyday Living Inventory (PELI) was used to assess importance of preferences among persons with CI. Care partners completed two separate PELI assessments: one from the perspective of the persons with CI (i.e., acting as a surrogate decision‐maker) and one from their own perspective. To assess for projection of care partners’ preferences onto surrogate assessments of preferences for persons with CI, two‐step regression with multivariable‐adjusted general linear models was used.ResultSignificant projection effects were noted within the PELI domains of autonomous choice, personal growth, and keeping a routine (p &lt; 0.0005). More significant cognitive impairment was associated with increased projection effects within the PELI domains of autonomous choice and personal growth (p &lt; 0.01)ConclusionThe results of this study suggest that projection effects of care partners own preferences may be a significant source of bias in everyday proxy decision‐making for persons with CI, particularly for those with more significant CI.

Exploring the Criterion Validity of Pragmatic Person-Centered Care/Culture Change Measures.

Nursing homes (NHs) are required to provide person-centered care, efforts often folded into broader culture change initiatives. Despite the known benefits of culture change, it is difficult to measure. This study aims to assess the criterion validity of the Preferences for Everyday Living Inventory (PELI) Implementation Indicator with other culture change measures. Using data from Ohio-based NHs (n = 771), logistic regression techniques demonstrated the relationship between the PELI Implementation Indicator and two validated culture change measures, the Resident Preferences for Care (RPC) and Certified Nursing Assistant (CNA) Empowerment scales. There was a significant relationship between the two scales and complete PELI implementation holding all other variables constant. The RPC and CNA Empowerment scales were significantly associated with complete PELI implementation. Findings suggest that the PELI Implementation Indicator can be used as a pragmatic indicator of a community's adoption of person-centered care and culture change.

Preference Importance Ratings among African American and White Nursing Home Residents

ABSTRACT Objectives The Preferences for Everyday Living Inventory (PELI-NH) assesses psychosocial preferences of nursing home (NH) residents. This study explored the association of race with importance ratings of self-dominion preferences (i.e., preferences for control). Methods PELI-NH interviews were conducted with 250 NH residents. Tests of mean differences compared African American (n = 57) and White (n = 193) residents on demographic (age, gender, education, length of stay) and clinical attributes (self-rated health, depressive symptoms, anxiety, functional limitations, hearing, vision, cognition). Stepwise multiple regression accounted first for associations of demographic and clinical attributes then for the unique association of race with total importance of self-dominion preferences to determine whether African American and White residents differ. For between group demographic/clinical differences, interaction effects were tested. Results African Americans were younger and more functionally impaired. After accounting for the effects of gender (female), age (younger), anxiety (greater), and functional impairment (less) with higher reports of importance of self-dominion preferences, race was significant. There were no significant moderating effects. Conclusions African American residents reported greater importance of self-dominion preferences than Whites. Clinical Implications Cultural sensitivity is critical; it may be more important to provide opportunities for autonomous decision-making for African American than for White residents.

Testing a Preference Tool in Different Care Settings in Germany: Descriptive Results

Background: The tool “Preferences for Everyday Living Inventory” (PELI) for Nursing Homes (NH) was developed in the USA. In our project PELI-D, the PELI was translated from English into German and piloted in three care settings: Nursing Home (NH), Home Care (HC) and Adult Day Care (AD). Objective: The objective is to provide insights in preferences of importance of older adults in need of care in Germany. Methods: Data collection was carried out in 2019 on multiple measurement points: n=48 baseline (T0) and n=41 two-week follow-up (T1). Results: The results indicate that the importance of certain preferences distinguishes between the care settings: In NH preferences for body care and aspects of professional care are important. Additionally, in HC the aspects of social contact and eating/drinking are perceived as important. Comparing T0 and T1, importance of the item’s daily routines, social contact and aspects of privacy seem to be reliable.

Longitudinal changes in neuropsychiatric symptoms: Impact of discrepancy in everyday preferences between people with cognitive impairment and their care partners

AbstractBackgroundNeuropsychiatric symptoms (NPS) of major neurocognitive disorders are common and debilitating facets of the illness process. Yet, little is known about the impact on NPS of discrepancy in the importance of everyday preferences between persons with cognitive impairment (CI) and proxy ratings by their care partners.MethodThe sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. NPS of the person with CI were measured using the Neuropsychiatric Inventory brief Questionnaire (NPI‐Q) and 15‐item Geriatric Depression Scale (GDS‐15) at baseline and follow‐up (mean 486 days). The Preferences for Everyday Living Inventory was used to assess importance of preferences for persons with CI at baseline; care partners separately completed concurrent proxy assessments at baseline. Mixed random and fixed effects longitudinal models were used to evaluate the impact of baseline discrepancy in everyday preferences assessment between persons with CI and their car partners on changes in NPS across time.ResultHigher levels of underestimation of the importance of “social engagement” preferences in the proxy ratings of care partners relative to the self‐ratings of persons with CI were associated with a higher degree of neuropsychiatric symptoms across time as a whole as measured by the NPI‐Q but not the GDS‐15.ConclusionThis study yields new insights into the relationship between discrepant importance ratings of “social engagement” preferences and neuropsychiatric manifestations of neurocognitive disorders, suggesting that a baseline level of discrepancy is associated with changes in neuropsychiatric symptoms over time. Resolving such discrepancies may then offer a therapeutic avenue to lessen NPS over time for persons with CI.

Longitudinal differences in everyday preferences: Comparisons between people with cognitive impairment and their care partners.

Persons with progressive cognitive impairment (CI) increasingly rely on surrogate decision-makers for everyday activities. Yet, little is known about changes in everyday preferences over time or about concordance between persons with CI and their care partners regarding longitudinal changes. The sample included 48 dyads of persons with CI (Clinical Dementia Rating Scale score ≥0.5) and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI at baseline and follow-up (mean 486 days). Care partners separately completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners. There were significant gender differences regarding importance ratings of "autonomous choice" and "social engagement" preferences over time: women with CI rated these preferences as more important across time as a whole. Higher levels of neuropsychiatric symptoms were associated with less importance of "social engagement" preferences across time as a whole for persons with CI and a more negative discrepancy between persons with CI and care partner proxy assessments as time went on. This study yields new insights into predictors of longitudinal change in everyday preferences among persons with CI and their care partners. Although preferences were largely stable over time, there is increasing support for the relationship between differences in "social engagement" preferences and neuropsychiatric symptoms, which may have implications for monitoring and/or treatment in the context of cognitive impairment.

Translation and culture sensitive adaptation of the PELI ("Preferences for Everyday Living Inventory") for nursing settings

Translation and culture sensitive adaptation of the PELI ("Preferences for Everyday Living Inventory") for nursing settings Abstract. Background: The consideration of individual preferences of people with care needs in the sense of person-centred care requires a systematic recording of preferences related to everyday living. Therefore, the Preferences for Everyday Living Inventory (PELI) was developed in the USA. Aim: The aim was to translate the current version of the PELI-NH© (Nursing Home), into German (PELI-D) and to adapt this version in a culturally sensitive manner home care, adult day care and nursing home. Methods: The German translation of the PELI-NH© was carried out in eleven steps according to the ISPOR principles. Central steps were the forward translations, the expert panel, the cognitive debriefing and the backward translations. Results: As result of the translation the PELI-D (72 items) is the first comprehensive instrument in German language to assess everyday preferences of people with care needs in home care (55 items), adult day care (54 items) und nursing home (65 items). Conclusion: The selected procedure supports a critical reflection of the translation process and ensures the culturally sensitive comparability of the source language and the target language. The practicability of three setting specific versions of PELI-D needs be examined in further studies.

Lessons Learned From Ohio's Statewide Implementation of the Preferences for Everyday Living Inventory as a Pay for Performance Initiative to Enhance Person-Centered Care

Person-centered care (PCC) in nursing homes is an elusive organizational goal that has attracted the attention of pay-for-performance (P4P) programs. P4P programs are used to incentivize providers to improve the quality of care delivered. However, P4P programs have both overarching policy initiatives (big “P”) that must incorporate an implementation framework that is adaptable in practice (little “p”). The purpose of this paper is to apply six key factors that are central to P4P design in long-term care settings: financial incentives, measurement, stakeholder involvement and alignment, feasibility, education and awareness, and reporting and transparency as a framework for a case study of a P4P initiative conducted in Ohio between 2015 and 2019. Notably, the case study is focused on PCC and how the Ohio Department of Medicaid selected the Preferences for Everyday Living Inventory (PELI) for nursing home providers to use with all of their residents. Although inclusion of the PELI met some of the key factors, such as measurement, its implementation did not meet other key factors, such as reporting and transparency. Based on lessons learned from the Ohio P4P, recommendations are presented for use of the PELI as both a process and outcome measure in future P4P initiatives.