Service-learning and patient safety in medical education: a pretest–posttest study with a complementary expert perspective

IntroductionHome- and community-based services (HCBS) may support quality of life among older adults when expected services are perceived as available. This study examined whether the number of expected HCBS perceived as available was associated with self-rated quality of life (QOL) contemporaneously and at the next scheduled survey wave.MethodsWe analyzed longitudinal data from the Longitudinal Healthy Longevity Survey. Contemporaneous analyses included 24,180 person-wave observations from 8,699 individuals and used individual fixed-effects linear probability models with survey-year effects. Prospective analyses included 20,974 adjacent-wave pairs from 13,386 individuals and adjusted for baseline QOL, covariates, and origin-year effects. Sensitivity analyses examined alternative outcome scales, model specifications, interval length, service domains, and subgroup interactions.ResultsIn the contemporaneous model, one additional expected perceived as available was associated with a 0.00841 higher probability of good/very good QOL (95% CI: 0.00408–0.01275). In the baseline-adjusted prospective analysis, the coefficient was 0.00338 (p = 0.089), decreasing to 0.00094 (p =0.662) when restricted to three-year intervals. Prospective findings varied by model and outcome specification.DiscussionMore expected HCBS perceived as available was associated with better contemporaneous self-rated QOL. Prospective evidence was weaker and sensitive to analytical specification. Findings should be interpreted as associations rather than causal effects and do not establish actual service use or objectively verified service provision.