Evaluation of health care services through a Latent Markov Model with covariates

In this work, we focus on the evaluation of the health care services provided to elderly patients by nursing homes of four different health districts in the Umbria region (Italy). For this purpose, we analyze data coming from a longitudinal survey aimed at assessing several aspects of patient health conditions. In the analysis, we employ an extended version of the latent Markov model with covariates that allows us to deal with dropout and non-monotone missing data, which are common in longitudinal studies. Maximum likelihood estimates are obtained by a two step approach that allows for fast estimation of the model parameters and prevents some drawbacks of the standard maximum likelihood approach encountered in the presence of many response variables and covariates. In the application to the observed data, we show how to obtain indicators of the effectiveness of the health care services delivered by each health district.