First Advisor

Barbara J. Stewart

Date of Publication

1-1-1983

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.) in Urban Studies

Department

Urban Studies and Planning

Language

English

Subjects

Urban planning, Area planning & development, Nursing homes -- Oregon

DOI

10.15760/etd.412

Physical Description

2, xi, 203 leaves

Abstract

The State of Oregon is using the Placement Information Base, PIB, as part of an assessment process to determine the type of placement needed by Medicaid clients. While used for functional assessment, PIB has not been empirically studied for its use as a screening or predictive instrument to differentiate between the need for nursing home care and community care. This dissertation addresses the question of whether PIB is suitable for use as a screening instrument for nursing home placement decisions. Both PIB's measurement and predictive capabilities are examined. Using secondary PIB data on 2287 elderly Department of Human Resources clients, four highly reliable scales were developed. Alpha coefficients range from .75 to .90. These scales were found to measure the theoretically important dimensions of Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Social functioning and Mental functioning. Ten discriminant function equations, using PIB items and scales as predictors, were developed and cross-validated to compare those elderly currently residing in the community and those currently residing in nursing homes (n = 1772). For each of the functions the predictive accuracy was at least 79 percent with the derivation sample and even higher with the cross-validation sample. Functions containing only single items predicted as well or better than those containing scales. A comparison between the discriminant function equations and three a priori decision rules accompanying the PIB indicate that each of the discriminant function equations is predictively equivalent to one of the a priori decision rules and superior to the other two. The findings of this dissertation suggest that any one of the discriminant functions or the very high probability a priori decision rule could be used as an equitable and economically feasible screening instrument for nursing home placement. The choice of a particular function or the decision rule should be guided by practical and theoretical considerations. Policy implications and suggestions for future research are discussed.

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Comments

Portland State University. School of Urban and Public Affairs.

Persistent Identifier

http://archives.pdx.edu/ds/psu/4509

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