information on effectiveness across the states1 was possible only for a limited number of variables. This approach was possible primarily for the “success” variables included in a recent study from the Office of the Inspector General of the Department of Health and Human Services (OIG, 1991a,b,c). The commissioned papers for the IOM study and surveys and interviews conducted by IOM staff, consultants, and committee members contributed new analyses and additional sources of information from state and local ombudsmen, SUAs, providers (e.g., nursing facility operators and medical directors), and advocacy groups (Chaitovitz, 1994a,b; Elon, 1994; Holstein, 1994; Hornbostel, 1994; Huber, 1994; Kautz, 1994; Lower, 1994; Lusky et al., 1994; NCCNHR, 1994; Phillips et al., 1994). Committee members and staff examined and reanalyzed many available data sources, searched the literature, conducted site visits, and held a national conference and hearings on effectiveness. Each step provided new information relevant to study questions on effectiveness.

This triangulated approach to data collection and analysis forms the basis of the committee’s assessment of program effectiveness. It relies on qualitative and quantitative data and represents a variation on meta-analysis in dealing with the multiple dimensions of effectiveness. The committee’s assessment is a collective product of the individual interpretations and expert opinions of the different committee members, who represent a range of professions and disciplines knowledgeable in LTC issues and who brought their informed judgment to bear on a variety of topics related to program effectiveness.

With respect to previous work on evaluation, the committee is indebted to the efforts by the ombudsmen themselves in developing monitoring and evaluation tools.2 The evaluations of the General Accounting Office (GAO, 1992b) and the OIG further contributed to the committee’s understanding of the complexities in conceptualizing and utilizing indicators of “quality” performance.

Quality as a Central Issue in Effectiveness

Although the ombudsman program is not directly responsible for assessing, assuring, or improving the quality of LTC services provided in LTC facilities,


An analysis of reliable and valid data across all states is essential to a full national “program” evaluation, in contrast to a specific individual state or local “project” evaluation (see Wholey et al, 1971).


Materials the committee found useful included: A Menu for Excellence: A Guide to Program Evaluation for the State Long-Term Care Ombudsman Program, from the National Eldercare Institute on Elder Abuse and State LTC Ombudsman Services (1993a); and Toward Quality Long-Term Care Ombudsman Programs, from the National Center for State LTC Ombudsman Resources (1991).

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