Chapter 2. Study Purpose and Search Strategy
The main goal of this environmental scan was to identify instruments that have been developed to assess consumer satisfaction with care, services delivered, and quality of life that could be used or adapted for assisted living. Instruments used in research in assisted living facilities, nursing homes, and other long-term care settings were reviewed.
Recommendations regarding further questionnaire development in this area will be made in conjunction with the findings from the other AHRQ assisted living initiatives mentioned previously (e.g., focus groups and State monitoring assessment) and from CAHPS® programs mentioned earlier that focus on other long-term care settings.
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Databases that were used for the search included the following:
- Medline, the National Library of Medicine database.
- Ageline, produced by AARP.
- Combined Index to Nursing and Allied Health Literature (CINAHL).
- Combined Health Information Database (CHID), produced by health-related agencies of the Federal Government; includes health promotion and education materials not indexed elsewhere.
- Health and Psychosocial Instruments (HAPI), which provides descriptions of measurement instruments (questionnaires, rating scales, tests, index measures, and checklists in the fields of public health, medicine, gerontology, etc).
- Health Source, which gives access to more than 550 full text journals focusing on many medical disciplines.
- Business Management, which contains articles on practical aspects of business.
- Current Index to Statistics.
- Public Affairs Information Service (PAIS), which covers the full range of the social sciences, with emphasis on contemporary public issues.
- PsychInfo, produced by the American Psychological Association, which includes coverage of methodology for the social and psychological sciences.
- Wilson Social Science Abstracts, which provides broad coverage of the social sciences.
- Psychline and Sage Social Research Methodology (SRM), which contains literature on social and behavioral research methodology.
Keywords used for the search could be generally grouped in four broad categories: facilities, services, assessment and research methods, and satisfaction and life style:
- Facilities—assisted living, assisted living facilities, homes for the aged, homes for the elderly, nursing homes, residential facilities, residential care, halfway houses, group homes, supported housing, housing with services, home care services, board and care, adult day care, senior centers, personal assistant services, personal care homes, home health care, home care, and home health.
- Services—health care services, health services, social work, social services, supportive services, services, activities, rehabilitation, therapy,
therapeutic, recreation, and recreational.
- Assessment and research methods—needs assessment, outcome and process assessment (health care), health services research methods, health services research standards, qualitative research, quality indicators, health care evaluation mechanisms, data collection, questionnaires, research techniques, test validity, tests, data quality, outcomes, instrument construction, instrument validation, evaluation, assessment, indicator, scale, instrument, questionnaire, and index.
- Satisfaction and life style—quality improvement; consumer satisfaction, personal satisfaction, care satisfaction, life satisfaction, patient satisfaction, patient participation, patient education, quality of life, quality of care, lifestyle, medication management, Alzheimer's disease, and developmental disability.
In addition, a list of authors' names was searched, including: M. Aud, K. Brown Wilson, K. Eckert, J. Garrard, S.M. Geron, L. Grant, C. Hawes, J. Hyde, B. Jackson, R.A. Kane, G.J. Kennedy, R. Mollica, C.D. Phillips, M. Rantz, P. Sloane, V. Tellis-Nayak, M. Wylde, and S.I. Zimmerman.
General Internet searches were conducted for organizations and services related to assisted living, including the following:
- Administration on Aging.
- Alzheimer's Association – Assisted Living page.
- American Assisted Living Nurses Association.
- American Association of Homes and Services for the Aging (AAHSA).
- American Health Care Association: National Center for Assisted Living (NCAL).
- American Seniors Housing Association (ASHA).
- American Society of Consultant Pharmacists.
- Assisted Living Division of the Commission on Accreditation of Rehabilitation Facilities (CARF).
- Assisted Living Federation of America (ALFA).
- Consumer Consortium on Assisted Living (CCAL).
- Joint Commission on Accreditation of Healthcare Organizations – Assisted Living page.
- Life Services Network.
- My InnerView.
- National Academy for State Health Policy (NASHP).
- National Investment Center for the Seniors Housing and Care Industry.
- National Long Term Care Ombudsman Resource Center.
- NCB Development Corporation: Affordable Assisted Living.
- ProMatura Group.
- The Robert Wood Johnson Foundation.
- Vital Research.
AHRQ staff provided several reference articles and reports. To gain an understanding
of current research activity, project staff attended the 2004 Gerontological
Society of America preconference meeting of the Assisted Living Special Interest
Group and the 2004 Center for Excellence in Assisted Living Quality Summit, "Achieving
Excellence," both held in Washington, DC. Project staff also conducted
general searches using Google™, solicited developers for instruments,
and networked by telephone with experts in the field, who then provided additional
contacts. While for-profit vendors who market assisted living satisfaction
instruments were contacted, some were reluctant to provide instruments or information
about their products.
Instruments included in this report generally have some evidence about acceptable
levels of reliability and/or construct validity. In some cases—when the
subject matter was considered important and no other instrument was available—an
instrument was included if it had strong face validity. Searches were limited
to instruments published and/or in use between January 1990 and March 2005.
Appendix A (700 KB; Plugin Software Help) presents the final list of instruments reviewed for this project. State mandated tools used to measure customer satisfaction with nursing home care and not referenced in the peer-reviewed literature generally are not included (Lowe, Lucas, Castle, et al., 2003; Castle, 2004b). Also excluded are instruments specifically intended to be used in non-long-term care residential settings (i.e., community, hospital, etc.). As a result, instruments developed for general purpose health care settings (e.g. Sofaer and Firminger, 2005), including home health care (e.g., Home Care Satisfaction Measure; Geron and Chasler, 1998; Geron, Smith, Tennstedt, et al., 2000) are excluded, as are instruments developed for the community-dwelling Alzheimer's population, including the Quality of Life in Dementia (QOL-D; Albert, Del Castillo-Castaneda, Sano, et al., 1996), Quality of Life in Alzheimer's Disease (QOL-AD; Logsdon, Gibbons, McCurry, and Teri, 2000), Alzheimer's Disease Related Quality of Life (ADRQL; Rabins, Kasper, Kleinman, et al., 2000), and the Dementia Quality of Life (DQoL; Brod, Stewart, and Sands, 2000). Since staffing measures are not the focus of this report, we did not systematically search for instruments on staffing; however, those that were identified using the stated search strategy were included.1 In addition, instruments in which the developer did not share the instrument with the scan team were excluded.
1 For additional details on long-term care staffing measures beyond those in this document, see the report Measuring Long-term Care Work: A Guide to Selected Instruments to Examine Direct Care Worker Experiences and Outcomes (Kiefer, Harris-Kojetin, Brannon, et al., 2005).
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