In other words, residents, providers, and others must be aware of the ombudsman program and have access to it, and an adequately funded and organized system must be in place to address the problems of LTC residents and to improve the quality of their care and lives. Basic access and capacity at the state and local level, as well as adequate oversight and support at the national level, are necessary but not sufficient conditions for effectiveness.

In examining effectiveness the committee considered several key prerequisites. These included: (a) the organizational infrastructure of the ombudsman program; (b) inputs to and resources for the program, such as the enabling legislation, financial and staffing resources, databases, and information systems; (c) processes and selected types of outputs, including ways of handling complaints and coordination with agencies involved in quality assurance; and (d) selected outcomes such as resolved complaints, resident satisfaction, and system change attributable in whole or in part to the program. The discussion on compliance in Chapter 3 is obviously relevant to the data review in the context of effectiveness; the compliance discussion focused chiefly on whether certain activities occurred but stopped short of assessing what were the outcomes of such activities.

Because federal and state policy and other environmental factors are changing in myriad ways—including the sweeping restructuring of the health care industry in the past decade and into the present—effectiveness must necessarily occur in the context of our evolving health care and social system. Changes in acute and LTC delivery and health care policy highlight both the growing importance of the ombudsman program (see Chapters 7 and 8) and the need to regularly monitor the effectiveness of the ombudsman program as it responds to changing conditions and new challenges.

The committee’s approach embraced two elements of research: triangulation and a variant of meta-analysis. “Triangulation” denotes the utilization of similar or complementary data from a number of sources to verify or validate program findings. Although the committee did not combine and reanalyze data, the committee applied a meta-analytic approach in the sense that it examined, compared, and analyzed previous qualitative and quantitative research findings on program effectiveness from multiple data sources.

Given the variability and lack of comparability in available 50-state data, the committee concluded that a comprehensive statistical approach to obtaining