Consumer-reported quality indicators for publicly funded home- and community-based services: development and...

Consumer-reported measures are important quality indicators for ensuring person-centeredness in home and community-based services (HCBS). However, administrative data commonly used to assess HCBS quality often lacks consumer-reported measures. To address this gap, we developed and validated novel consumer-reported quality indicators using data from the National Core Indicators-Aging and Disability (NCI-AD) Adult Consumer Survey.

We conducted exploratory factor analyses using the 2018-2019 survey wave of NCI-AD (n = 5,572 community-dwellingolder consumers, age ≥65 years) and identified seven QIs. We then confirmed the validity of these seven new QIs in 2 ways: (a) qualitatively through a technical expert panel (for face validity and contextualization) and (b) quantitatively, using confirmatory factor analyses in the 2017-2018 survey wave (n = 9,145 community-dwelling consumers, age ≥65 years).

The seven validated QIs were service satisfaction, staff quality, environmental safety, service decision-making, daily life decision-making, community inclusion, and overall health and quality of life. Internal consistency was strong across domains (Cronbach's alpha = 0.63-0.89; McDonald's omega = 0.70-0.90). Exploratory analyses also identified differences in selected QI scores by dementia status and age.

These seven consumer-reported QIs provide a practical, validated framework for evaluating person-centered HCBS quality. They can support researchers, providers, and policymakers in monitoring service quality, identifying modifiable targets for improvement, and advancing quality measurement in publicly funded HCBS.