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Home and Community-Based Services: A Systematic Review and Evidence Map.

M Hassan Murad1, Tarek Nayfeh2, Samer Saadi2

  • 1Mayo Clinic Evidence-Based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA. Murad.mohammad@mayo.edu.

Journal of General Internal Medicine
|August 13, 2024
PubMed
Summary

Home and Community-Based Services (HCBS) support independence for older adults with functional limitations. This review maps HCBS evidence, identifying gaps in research and policy for better care delivery.

Keywords:
evidence mapfunctional disabilitieshome and community-based servicesperson-centered planningperson-centerednesssystematic review

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Area of Science:

  • Gerontology
  • Health Services Research
  • Public Health Policy

Background:

  • Older adults (60+) often face functional limitations, necessitating Home and Community-Based Services (HCBS) to maintain independence and avoid institutionalization.
  • A systematic review was conducted to map the existing evidence on HCBS, aiming to identify critical gaps for future research and policy development.

Purpose of the Study:

  • To systematically map the existing literature on Home and Community-Based Services (HCBS) for older adults.
  • To identify evidence gaps in populations, interventions, outcomes, person-centeredness, and quality measures related to HCBS.
  • To inform future research priorities and policy decisions regarding HCBS.

Main Methods:

  • A comprehensive literature search was performed across multiple databases (Medline, Embase, Scopus) up to December 7, 2023.
  • Stakeholder interviews were conducted to gather diverse perspectives on HCBS.
  • Narrative and thematic synthesis was employed to analyze HCBS literature concerning populations, interventions, outcomes, person-centeredness, and quality.

Main Results:

  • 27 primary studies and 29 quality measures were identified, covering populations with functional disability, cognitive impairment, and high-risk conditions.
  • Interventions included person-centered planning, dementia care, rehabilitation, self-directed care, and care coordination; however, person-centeredness and social needs were underrepresented.
  • Numerous quality measures exist, but challenges include limited randomized trials, inadequate intervention descriptions, and insufficient data on facilitators, barriers, and workforce issues.

Conclusions:

  • The current evidence map highlights the state of research on HCBS for older adults.
  • Significant evidence gaps exist, particularly concerning the explicit description of person-centered planning, self-direction, and addressing health-related social needs.
  • Further research is needed to address intervention details, facilitators, barriers, workforce challenges, and to strengthen the evidence base for effective HCBS policy and practice.