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Harrison J, Berry S, Mor V, Gifford D. "Somebody Like Me": Understanding COVID-19 Vaccine Hesitancy among Staff in Skilled Nursing Facilities. J Am Med Dir Assoc 2021; 22:1133-1137. [PMID: 33861978 PMCID: PMC7980134 DOI: 10.1016/j.jamda.2021.03.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Abstract
Objective The vaccination of skilled nursing facility (SNF) staff is a critical component in the battle against COVID-19. Together, residents and staff constitute the single most vulnerable population in the pandemic. The health of these workers is completely entangled with the health of those they care for. Vaccination of SNF staff is key to increasing uptake of the vaccine, reducing health disparities, and reopening SNFs to visitors. Yet, as the vaccine rollout begins, some SNF staff are declining to be vaccinated. The purpose of this article is to describe reasons for COVID-19 vaccine hesitancy reported by staff of skilled nursing facilities and understand factors that could potentially reduce hesitancy. Design Five virtual focus groups were conducted with staff of SNFs as part of a larger project to improve vaccine uptake. Setting and Participants Focus groups with 58 staff members were conducted virtually using Zoom. Measures Focus groups sought to elicit concerns, perspectives, and experiences related to COVID-19 testing and vaccination. Results Our findings indicate that some SNF staff are hesitant to receive the COVID-19 vaccine. Reasons for this hesitancy include beliefs that the vaccine has been developed too fast and without sufficient testing; personal fears about pre-existing medical conditions, and more general distrust of the government. Conclusions and Implications SNF staff indicate that seeing people like themselves receive the vaccination is more important than seeing public figures. We discuss the vaccination effort as a social enterprise and the need to develop long-term care provider-academic-community partnerships in response to COVID-19 and in expectation of future pandemics.
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Affiliation(s)
- Jill Harrison
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
| | - Sarah Berry
- Hebrew SeniorLife, Hinda and Arthur Marcus Institute for Aging Research, & Harvard Medical School, Boston, MA, USA
| | - Vince Mor
- Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - David Gifford
- Center for Health Policy Evaluation in Long-Term Care, American Health Care Association, Washington, DC, USA
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Appaneal HJ, Caffrey AR, Lopes VV, Mor V, Dosa DM, LaPlante KL, Shireman TI. Predictors of potentially suboptimal treatment of urinary tract infections in long-term care facilities. J Hosp Infect 2021; 110:114-121. [PMID: 33549769 DOI: 10.1016/j.jhin.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Suboptimal antibiotic treatment of urinary tract infection (UTI) is high in long-term care facilities (LTCFs) and likely varies between facilities. Large-scale evaluations have not been conducted. AIM To identify facility-level predictors of potentially suboptimal treatment of UTI in Veterans Affairs (VA) LTCFs and to quantify variation across facilities. METHODS This was a retrospective cohort study of 21,938 residents in 120 VA LTCFs (2013-2018) known as Community Living Centers (CLCs). Potentially suboptimal treatment was assessed from drug choice, dose frequency, and/or treatment duration. To identify facility characteristics predictive of suboptimal UTI treatment, LTCFs with higher and lower rates of suboptimal treatment (≥median, < median) were compared using unconditional logistic regression models. Joinpoint regression models were used to quantify average percentage difference across facilities. Multilevel logistic regression models were used to quantify variation across facilities. FINDINGS The rate of potentially suboptimal antibiotic treatment varied from 1.7 to 34.2 per 10,000 bed-days across LTCFs. The average percentage difference in rates across facilities was 2.5% (95% confidence interval (CI): 2.4-2.7). The only facility characteristic predictive of suboptimal treatment was the incident rate of UTI per 10,000 bed-days (odds ratio: 4.9; 95% CI: 2.3-10.3). Multilevel models demonstrated that 94% of the variation between facilities was unexplained after controlling for resident and CLC characteristics. The median odds ratio for the full multilevel model was 1.37. CONCLUSION Potentially suboptimal UTI treatment was variable across VA LTCFs. However, most of the variation across LTCFs was unexplained. Future research should continue to investigate factors that are driving suboptimal antibiotic treatment in LTCFs.
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Affiliation(s)
- H J Appaneal
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA; College of Pharmacy, University of Rhode Island, Kingston, RI, USA; Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
| | - A R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA; College of Pharmacy, University of Rhode Island, Kingston, RI, USA; Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - V V Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - V Mor
- Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - D M Dosa
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - K L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, USA; College of Pharmacy, University of Rhode Island, Kingston, RI, USA; Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI, USA
| | - T I Shireman
- Center for Gerontology & Health Care Research and Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Gravenstein S, McConeghy KW, Saade E, Davidson HE, Canaday DH, Han L, Rudolph J, Joyce N, Dahabreh IJ, Mor V. Adjuvanted influenza vaccine and influenza outbreaks in U.S. nursing homes: Results from a pragmatic cluster-randomized clinical trial. Clin Infect Dis 2021; 73:e4229-e4236. [PMID: 33400778 DOI: 10.1093/cid/ciaa1916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza outbreaks in nursing homes pose a threat to frail residents and occur even in vaccinated populations. We conducted a pragmatic cluster-randomized trial comparing adjuvanted trivalent influenza vaccine (aTIV) versus trivalent influenza vaccine (TIV). Here, we report an exploratory analysis to compare the effect of aTIV versus TIV on facility-reported influenza outbreaks. METHODS Nursing homes were randomized to offer older residents either aTIV or TIV for the 2016-17 influenza season. The impact of the intent-to-treat vaccine assignment was evaluated for the total number of outbreaks reported from November-March. We collected data according to standard CDC definitions for both suspected outbreaks and those with a laboratory-confirmed case in nursing homes, and adjusted for facility-level vaccination rates and resident characteristics. RESULTS Of 823 randomized nursing homes, 777 (aTIV, n=387; TIV, n=390) reported information on influenza outbreaks. The treatment groups had similar characteristics at baseline except for race/ethnicity: homes assigned to TIV had a higher percentage of African-American residents (18.0% versus 13.7%). There were 133 versus 162 facility-reported suspected influenza outbreaks in aTIV versus TIV facilities respectively, of these 115 versus 140 were laboratory confirmed. The aTIV group experienced a 17% reduction in suspected (rate ratio, RR, 0.83, 95% confidence interval, CI: 0.65, 1.05) and laboratory-confirmed influenza outbreaks (RR 0.83, 95%CI: 0.63, 1.06). Covariate adjustment increased the estimated reduction for suspected outbreaks to 21% (RR 0.79, 95%CI: 0.61, 0.99) and 22% for laboratory confirmed (RR 0.78, 95%CI: 0.60, 1.02). CONCLUSIONS In an exploratory analysis of a cluster-RCT we observed 17-21% fewer outbreaks with aTIV than TIV.ClinicalTrials.gov number, NCT02882100.
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Affiliation(s)
- Stefan Gravenstein
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States
| | - Kevin W McConeghy
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Elie Saade
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | | | - David H Canaday
- University Hospitals Cleveland Medical Center, Cleveland Ohio, United States.,Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States
| | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, Virginia, United States
| | - James Rudolph
- Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Nina Joyce
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Issa J Dahabreh
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, Rhode Island, United States
| | - Vince Mor
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, United States.,Center for Long-Term Quality & Innovation, Brown University School of Public Health, Providence, Rhode Island, United States
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McConeghy KW, White E, Panagiotou OA, Santostefano C, Halladay C, Feifer RA, Blackman C, Rudolph JL, Mor V, Gravenstein S. Temperature Screening for SARS-CoV-2 in Nursing Homes: Evidence from Two National Cohorts. J Am Geriatr Soc 2020; 68:2716-2720. [PMID: 33034046 PMCID: PMC7675320 DOI: 10.1111/jgs.16876] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Infection screening tools classically define fever as 38.0°C (100.4°F). Frail older adults may not mount the same febrile response to systemic infection as younger or healthier individuals. We evaluate temperature trends among nursing home (NH) residents undergoing diagnostic SARS-CoV-2 testing and describe the diagnostic accuracy of temperature measurements for predicting test-confirmed SARS-CoV-2 infection. DESIGN Retrospective cohort study evaluating diagnostic accuracy of pre-SARS-CoV-2 testing temperature changes. SETTING Two separate NH cohorts tested diagnostically (e.g., for symptoms) for SARS-CoV-2. PARTICIPANTS Veterans residing in Veterans Affairs (VA) managed NHs and residents in a private national chain of community NHs. MEASUREMENTS For both cohorts, we determined the sensitivity, specificity, and Youden's index with different temperature cutoffs for SARS-CoV-2 polymerase chain reaction results. RESULTS The VA cohort consisted of 1,301 residents in 134 facilities from March 1, 2020, to May 14, 2020, with 25% confirmed for SARS-CoV-2. The community cohort included 3,368 residents spread across 282 facilities from February 18, 2020, to June 9, 2020, and 42% were confirmed for SARS-CoV-2. The VA cohort was younger, less White, and mostly male. A temperature testing threshold of 37.2°C has better sensitivity for SARS-CoV-2, 76% and 34% in the VA and community NH, respectively, versus 38.0°C with 43% and 12% sensitivity, respectively. CONCLUSION A definition of 38.0°C for fever in NH screening tools should be lowered to improve predictive accuracy for SARS-CoV-2 infection. Stakeholders should carefully consider the impact of adopting lower testing thresholds on testing availability, cost, and burden on staff and residents. Temperatures alone have relatively low sensitivity/specificity, and we advocate any threshold be used as part of a screening tool, along with other signs and symptoms of infection.
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Affiliation(s)
- Kevin W McConeghy
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Elizabeth White
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Orestis A Panagiotou
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christopher Santostefano
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christopher Halladay
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | | | | | - James L Rudolph
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vince Mor
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Stefan Gravenstein
- Department of Veterans Affairs, Center on Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Care, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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McConeghy KW, Davidson HE, Canaday DH, Han L, Saade E, Mor V, Gravenstein S. Cluster-randomized trial of adjuvanted vs. non-adjuvanted trivalent influenza vaccine in 823 U.S. nursing homes. Clin Infect Dis 2020; 73:e4237-e4243. [PMID: 32882710 DOI: 10.1093/cid/ciaa1233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Influenza leads in preventable infection-related hospitalization in nursing home (NH) residents. The adjuvanted trivalent influenza vaccine (aTIV) is more immunogenic than similarly-dosed non-adjuvanted trivalent influenza vaccine (TIV) and observational studies suggest aTIV better prevents hospitalizations in older adults. We prospectively tested this in a NH setting. METHODS NHs with ≥ 50 long-stay residents ≥ 65 years were randomized to offer aTIV or TIV for residents for the 2016-17 influenza season. Using intent-to-treat resident-level analysis with Cox proportional hazards regression models adjusted for clustering by facility and a priori baseline covariates (e.g., age, heart failure, and facility-level characteristics), we assessed relative aTIV:TIV effectiveness for hospitalization [i.e., all-cause, respiratory, and pneumonia and influenza, (P&I)]. RESULTS We randomized 823 NHs, housing 50,012 eligible residents, to aTIV or TIV. Residents were similar between groups by age (mean, ~79), heart failure, lung disease, and influenza and pneumococcal vaccine uptake, except aTIV homes housed fewer Black residents (14.5 vs. 18.9%). Staff vaccine uptake was similar (~55%). P&I and all-cause resident hospitalization rates were lower (adjusted HR 0.80, 95% CI: 0.66, 0.98, p=0.03; aHR 0.94, 95% CI: 0.89, 0.99, p=0.02, respectively) for aTIV vs TIV, while the respiratory hospitalization rate was similar, in a season where vaccine effectiveness was considered poor. CONCLUSIONS aTIV was more effective than TIV in preventing all-cause and P&I hospitalization from NHs during an A/H3N2 predominant season when TIV was relatively ineffective.Funded by Seqirus. ClinicalTrials.gov number, NCT02882100.
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Affiliation(s)
- Kevin W McConeghy
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,School of Public Health, Brown University, Providence, Rhode Island, United States
| | | | - David H Canaday
- Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States.,University Hospitals Cleveland Medical Center, Cleveland Ohio, United States
| | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, Virginia, United States
| | - Elie Saade
- Louis Stokes Veterans Administration Center, Cleveland Ohio, United States.,Department of Medicine, Case Western Reserve University, Cleveland Ohio, United States.,University Hospitals Cleveland Medical Center, Cleveland Ohio, United States
| | - Vince Mor
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, United States
| | - Stefan Gravenstein
- Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, United States.,School of Public Health, Brown University, Providence, Rhode Island, United States.,Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island, United States
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Wang V, Swaminathan S, Corneau E, Maciejewski M, Trivedi A, O'Hare A, Mor V. Improving the Value of Care for Veterans: Impacts of VA Payment Reform for Community‐Based Dialysis. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- V. Wang
- Durham VA Health Care System Durham NC United States
| | - S. Swaminathan
- Brown University School of Public Health Providence RI United States
| | - E. Corneau
- Providence VA Medical Center Providence RI United States
| | | | - A. Trivedi
- Brown University School of Public Health Providence RI United States
| | - A. O'Hare
- Veterans Affairs of Puget Sound Health Care System Seattle WA United States
| | - V. Mor
- Brown University Providence RI United States
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Rudolph JL, Halladay CW, Barber M, McConeghy KW, Mor V, Nanda A, Gravenstein S. Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2. J Am Med Dir Assoc 2020; 21:895-899.e1. [PMID: 32674815 PMCID: PMC7280121 DOI: 10.1016/j.jamda.2020.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 01/08/2023]
Abstract
Objectives Many nursing home residents infected with SARS-CoV-2 fail to be identified with standard screening for the associated COVID-19 syndrome. Current nursing home COVID-19 screening guidance includes assessment for fever, defined as a temperature of at least 38.0°C. The objective of this study was to describe the temperature changes before and after universal testing for SARS-CoV-2 in nursing home residents. Design Cohort study. Setting and Participants The Veterans Administration (VA) operates 134 Community Living Centers (CLC), similar to nursing homes, that house residents who cannot live independently. VA guidance to CLCs directed daily clinical screening for COVID-19 that included temperature assessment. Measures All CLC residents (n = 7325) underwent SARS-CoV-2 testing. We report the temperature in the window of 14 days before and after universal SARS-CoV-2 testing among CLC residents. Baseline temperature was calculated for 5 days before the study window. Results SARS-CoV-2 was identified in 443 (6.0%) residents. The average maximum temperature in SARS-CoV-2–positive residents was 37.66 (0.69) compared with 37.11 (0.36) (P = .001) in SARS-CoV-2–negative residents. Temperatures in those with SARS-CoV-2 began rising 7 days before testing and remained elevated during the 14-day follow-up. Among SARS-CoV-2–positive residents, only 26.6% (n = 118) met the fever threshold of 38.0°C during the survey period. Most residents (62.5%, n = 277) with confirmed SARS-CoV-2 did experience 2 or more 0.5°C elevations above their baseline values. One cohort of SARS-CoV-2 residents' (20.3%, n = 90) temperatures never deviated >0.5°C from baseline. Conclusions and Implications A single screening for temperature is unlikely to detect nursing home residents with SARS-CoV-2. Repeated temperature measurement with a patient-derived baseline can increase sensitivity. The current fever threshold as a screening criteria for SARS-CoV-2 infection should be reconsidered.
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Affiliation(s)
- James L Rudolph
- Providence Veterans Administration Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI.
| | | | - Malisa Barber
- Providence Veterans Administration Medical Center, Providence, RI
| | | | - Vince Mor
- Providence Veterans Administration Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI
| | - Aman Nanda
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Stefan Gravenstein
- Providence Veterans Administration Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI
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Roydhouse JK, Gutman R, Keating NL, Mor V, Wilson IB. Propensity scores for proxy reports of care experience and quality: are they useful? Health Serv Outcomes Res Method 2019. [DOI: 10.1007/s10742-019-00205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kumar A, Adhikari D, Karmarkar A, Freburger J, Gozalo P, Mor V, Resnik L. Variation in Hospital-Based Rehabilitation Services Among Patients With Ischemic Stroke in the United States. Phys Ther 2019; 99:494-506. [PMID: 31089705 PMCID: PMC6489167 DOI: 10.1093/ptj/pzz014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/23/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about variation in use of rehabilitation services provided in acute care hospitals for people who have had a stroke. OBJECTIVE The objective was to examine patient and hospital sources of variation in acute care rehabilitation services provided for stroke. DESIGN This was a retrospective, cohort design. METHODS The sample consisted of Medicare fee-for-service beneficiaries with ischemic stroke admitted to acute care hospitals in 2010. Medicare claims data were linked to the Provider of Services file to gather information on hospital characteristics and the American Community Survey for sociodemographic data. Chi-square tests compared patient and hospital characteristics stratified by any rehabilitation use. We used multilevel, multivariable random effect models to identify patient and hospital characteristics associated with the likelihood of receiving any rehabilitation and with the amount of therapy received in minutes. RESULTS Among 104,295 patients, 85.2% received rehabilitation (61.5% both physical therapy and occupational therapy; 22.0% physical therapy only; and 1.7% occupational therapy only). Patients received 123 therapy minutes on average (median [SD] = 90.0 [99.2] minutes) during an average length of stay of 4.8 [3.5] days. In multivariable analyses, male sex, dual enrollment in Medicare and Medicaid, prior hospitalization, ICU stay, and feeding tube were associated with lower odds of receiving any rehabilitation services. These same variables were generally associated with fewer minutes of therapy. Patients treated by tissue plasminogen activator, in limited-teaching and nonteaching hospitals, and in hospitals with inpatient rehabilitation units, were more likely to receive more therapy minutes. LIMITATION The findings are limited to patients with ischemic stroke. CONCLUSION Only 61% of patients with ischemic stroke received both physical therapy and occupational therapy services in the acute setting. We identified considerable variation in the use of rehabilitation services in the acute care setting following a stroke.
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Affiliation(s)
- Amit Kumar
- College of Health and Human Services, Northern Arizona University, 208 E. Pine Knoll Dr, Flagstaff, AZ 86011 (USA); and Department of Health Services, Policy, and Practices, School of Public Health, Brown University, Providence, Rhode Island,Address all correspondence to Dr Kumar at:
| | - Deepak Adhikari
- Department of Health Services, Policy, and Practices, School of Public Health, Brown University
| | - Amol Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Janet Freburger
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro Gozalo
- Department of Health Services, Policy, and Practices, School of Public Health, Brown University; and Providence Veterans Affairs Medical Center, Providence, Rhode Island
| | - Vince Mor
- Department of Health Services, Policy, and Practices, School of Public Health, Brown University; and Providence Veterans Affairs Medical Center
| | - Linda Resnik
- Department of Health Services, Policy, and Practices, School of Public Health, Brown University; and Providence Veterans Affairs Medical Center
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Ferdows NB, Rahman M, Mor V. ACO AND NON-ACO AFFILIATED HOSPITALS DISCHARGE PATTERN TO SNFS BASED ON SNFS STAR RATING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - M Rahman
- Department of Health Services, Policy and Practice, Brown University
| | - V Mor
- Brown University School of Public Health
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11
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Shepherd-Banigan M, Jutkowitz E, Smith VA, Belanger E, Plassman BL, Van Houtven C, Mor V. PREDICTORS OF LONG-TERM CARE PREFERENCES OF PERSONS WITH MILD COGNITIVE IMPAIRMENT AND DEMENTIA AND CARE PARTNERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Shepherd-Banigan
- Department of Population Health Sciences, Duke University, Durham, North Carolina,United States
| | | | | | | | | | | | - V Mor
- Brown University, Providence, RI, USA
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Mor V, McHugh JP, Shield RR, Winblad U, Gadbois EA, Tyler DA. THE UNINTENDED CONSEQUENCES OF REDUCED SKILLED NURSING FACILITY LENGTH OF STAY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Mor
- Brown University School of Public Health, Providence, Rhode Island, United States
| | - J P McHugh
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - R R Shield
- Brown University School of Public Health, Providence, RI
| | | | - E A Gadbois
- Brown University School of Public Health, Providence, RI, USA
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Berry S, Zullo AR, Lee Y, Daiello L, McConeghy K, Zhang T, Mor V, Kiel DP. FRACTURE RISK ASSESSMENT IN LONG-TERM CARE (FRAIL) PREDICTS NON-VERTEBRAL FRACTURES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Berry
- Hebrew SeniorLife, Boston, Massachusetts, United States
| | - A R Zullo
- Brown University School of Public Health, Providence, RI, USA
| | - Y Lee
- Brown University School of Public Health, Providence, RI, USA
| | - L Daiello
- Brown University School of Public Health, Providence, RI, USA
| | - K McConeghy
- Brown University School of Public Health, Providence, RI, USA
| | - T Zhang
- Brown University School of Public Health, Providence, RI, USA
| | - V Mor
- Brown University School of Public Health, Providence, RI, USA
| | - D P Kiel
- Institute for Aging Research, Hebrew SeniorLife & BIDMC, Harvard Medical School, Boston, MA, USA
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Belanger E, Jutkowitz E, Shepherd-Banigan M, Van Houtven C, Plassman BL, Wetle T, Mor V. END-OF-LIFE CARE PREFERENCES OF PERSONS WITH MILD COGNITIVE IMPAIRMENT/DEMENTIA AND THEIR CARE PARTNERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Belanger
- Brown University, Providence, Rhode Island, United States
| | - E Jutkowitz
- Brown University School of Public Health, Providence, RI, USA
| | | | | | | | - T Wetle
- School of Public Health, Brown University, Providence, RI, USA
| | - V Mor
- Center for Gerontology and Healthcare Research, School of Public Health, Providence, RI, USA
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Jutkowitz E, Van Houtven C, Plassman BL, Mor V. RISK TAKING ATTITUDES AMONG PERSONS WHO RECEIVED AN AMYLOID PET SCAN AND THEIR CARE PARTNERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E Jutkowitz
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA, Providence, Rhode Island, United States
| | | | | | - V Mor
- Department of Health Services for Policy and Practice, Center for Gerontology and Healthcare Research, Providence, RI, USA
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Gadbois EA, Tyler DA, Shield RR, McHugh JP, Winblad U, Trivedi A, Mor V. MEDICARE ADVANTAGE CONTROL OF POST-ACUTE COSTS: PERSPECTIVES FROM PLANS, HOSPITALS, AND SKILLED NURSING FACILITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E A Gadbois
- Brown University, Providence, Rhode Island, United States
| | | | - R R Shield
- Brown University School of Public Health, Providence, RI
| | - J P McHugh
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - A Trivedi
- Brown University School of Public Health, Providence, RI
| | - V Mor
- Brown University School of Public Health, Providence, RI, USA
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Rivera-Hernandez M, Panagiotou O, Rahman M, Kumar A, Mor V, Trivedi A. RACIAL AND ETHNIC DISPARITIES IN 30-DAY READMISSION RATES IN MEDICARE ADVANTAGE AND MEDICARE FEE-FOR-SERVICE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - M Rahman
- Department of Health Services, Policy and Practice, Brown University
| | | | - V Mor
- Brown University School of Public Health
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Cornell P, Makineni R, Mor V. TRENDS IN HOSPITAL ADMISSIONS FROM VETERANS ADMINISTRATION NURSING HOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - V Mor
- Brown University School of Public Health
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McCreedy E, Mor V, Mitchell S, Loomer L. ESTABLISHING RATE OF CONVERSION FROM FULL CODE TO DO NOT RESUSCITATE STATUS AMONG LONG-STAY NURSING HOME RESIDENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E McCreedy
- Center for Gerontology and Healthcare Research, Brown University
| | - V Mor
- Brown University School of Public Health
| | | | - L Loomer
- Department of Health Services, Policy and Practice, Brown University, Providence, RI, USA
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20
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Fashaw S, Chisholm L, Mor V, Thomas K, Liu A, Gammonley D. THE USE OF PHYSICAL AND CHEMICAL RESTRAINTS AMONG NURSING HOME RESIDENTS OVER TIME: AN ISSUE OF HEALTH EQUITY? Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - V Mor
- Brown University School of Public Health
| | | | - A Liu
- University of Central Florida
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21
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Schmidt C, Mor V, Resnik L, Ogarek J. PHYSICAL THERAPY OR SURGERY FOR LUMBAR STENOSIS: ASSOCIATING FACTORS AND HEALTHCARE UTILIZATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Schmidt
- Center on Health Services Training and Research, Brown University
| | - V Mor
- Brown School of Public Health, Florence Pirce Grant University Professor
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McHugh J, Shield RR, Tyler DA, Gadbois EA, Winblad U, Mor V. DIVERGENT APPROACHES TO POST-ACUTE CARE MANAGEMENT – A CASE FOR RELATIONAL COORDINATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J McHugh
- Mailman School of Public Health, Columbia University, New York, New York, United States
| | - R R Shield
- Brown University School of Public Health, Providence, RI
| | | | - E A Gadbois
- Brown University School of Public Health, Providence, RI, USA
| | | | - V Mor
- Brown University School of Public Health, Providence, RI, USA
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Tyler D, Gadbois EA, McHugh JP, Shield RR, Winblad U, Mor V. HOW “PATIENT CHOICE” AFFECTS HOSPITAL RECOMMENDATIONS OF SKILLED NURSING FACILITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Tyler
- RTI International, Hancock, Maine, United States
| | - E A Gadbois
- Brown University School of Public Health, Providence, RI, USA
| | - J P McHugh
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - R R Shield
- Brown University School of Public Health, Providence, RI
| | | | - V Mor
- Brown University School of Public Health, Providence, RI, USA
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24
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Mor V. FROM CLINICAL ASSESSMENTS TO POPULATION DATA: FROM VISION TO REALITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- V. Mor
- Health Services, Policy & Practice, Brown University, Providence, Rhode Island,
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Affiliation(s)
- J.D. Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - V. Mor
- Brown University, Providence, Rhode Island
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Jarrin O, Crystal S, Mor V. OPTIMIZING THE NURSING HOME ENVIRONMENT FOR PEOPLE LIVING WITH DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O.F. Jarrin
- Rutgers, The State University of New Jersey, Devon, Pennsylvania
| | - S. Crystal
- Rutgers University, New Brunswick, New Jersey
| | - V. Mor
- Brown University, Providence, Rhode Island
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Thomas K, Dosa D, Gozalo P, Mor V. HEALTHCARE UTILIZATION OF ASSISTED LIVING RESIDENTS ACROSS THE UNITED STATES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Thomas
- Brown University, Providence, Rhode Island,
- U.S. Department of Veterans Affairs, Providence, Rhode Island
| | - D.M. Dosa
- Brown University, Providence, Rhode Island,
- U.S. Department of Veterans Affairs, Providence, Rhode Island
| | - P. Gozalo
- Brown University, Providence, Rhode Island,
| | - V. Mor
- Brown University, Providence, Rhode Island,
- U.S. Department of Veterans Affairs, Providence, Rhode Island
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Zullo A, Lee Y, Daiello L, Mor V, Boscardin J, Dore D, Steinman M. IMPACT OF BETA BLOCKERS ON FUNCTIONAL OUTCOMES IN NURSING HOME RESIDENTS AFTER MYOCARDIAL INFARCTION. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A.R. Zullo
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island,
| | - Y. Lee
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island,
| | - L. Daiello
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island,
| | - V. Mor
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island,
| | - J. Boscardin
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, San Francisco, California,
- Division of Biostatistics, University of California San Francisco, San Francisco, California,
| | - D. Dore
- Optum Epidemiology, Boston, Massachusetts
- Health Services, Policy, and Practice, Brown University, Providence, Rhode Island,
| | - M. Steinman
- Division of Geriatrics, University of California San Francisco and the San Francisco VA Medical Center, San Francisco, California,
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Affiliation(s)
- K. Thomas
- Brown University, Providence, Rhode Island,
- U.S. Department of Veterans Affairs, Providence, Rhode Island
| | - C. Kosar
- Brown University, Providence, Rhode Island,
| | - V. Mor
- Brown University, Providence, Rhode Island,
- U.S. Department of Veterans Affairs, Providence, Rhode Island
| | - R. Baier
- Brown University, Providence, Rhode Island,
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Teno J, Freedman V, Gozalo P, Kasper J, Mor V. LATE TRANSITIONS AND BEREAVED FAMILY MEMBER PERCEPTION OF QUALITY OF END-OF-LIFE CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J.M. Teno
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington,
| | | | - P. Gozalo
- Center for Gerontology and Health Care Research, Providence, Rhode Island,
| | - J.D. Kasper
- John Hopkins University, Baltimore, Maryland
| | - V. Mor
- Center for Gerontology and Health Care Research, Providence, Rhode Island,
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Mor V, Olshansky S. GSA DONALD P. KENT AWARD LECTURE AND ROBERT W. KLEEMEIER AWARD LECTURE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V. Mor
- Brown University, Providence, Rhode Island
| | - S. Olshansky
- University of Illinois at Chicago, Chicago, Illinois
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Teno J, Gozalo P, Trivedi A, Meltzer D, Mor V. WHO WILL CARE FOR ME WHEN I HAVE END-STAGE DEMENTIA? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J.M. Teno
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington,
| | - P. Gozalo
- Center for Gerontology and Health Care Research, Providence, Rhode Island,
| | - A. Trivedi
- Center for Gerontology and Health Care Research, Providence, Rhode Island,
| | - D. Meltzer
- University of Chicago, Chicago, Illinois
| | - V. Mor
- Center for Gerontology and Health Care Research, Providence, Rhode Island,
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Rivera-Hernandez M, Rahman M, Mor V, Trivedi A. SKILLED NURSING FACILITIES THAT DISPROPORTIONATELY SERVE MEDICARE BENEFICIERIES IN THE U.S. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M. Rahman
- Brown University, Providence, Rhode Island
| | - V. Mor
- Brown University, Providence, Rhode Island
| | - A. Trivedi
- Brown University, Providence, Rhode Island
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Intrator O, Kelley K, Mor V. VETERANS HEALTH ADMINISTRATION GERIATRICS AND EXTENDED CARE HOME AND COMMUNITY-BASED PROGRAMS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - K. Kelley
- Veterans Health Administration, Washington, District of Columbia
| | - V. Mor
- Brown University, Providence, Rhode Island
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Kosar C, Thomas K, Mor V. THE ADVERSE IMPACT OF OBESITY FOR POST-ACUTE NURSING HOME RESIDENTS WITH HIP FRACTURE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Kosar
- Brown University, Providence, Rhode Island
| | - K. Thomas
- Brown University, Providence, Rhode Island
| | - V. Mor
- Brown University, Providence, Rhode Island
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Ankuda CK, Mitchell SL, Gozalo P, Mor V, Meltzer D, Teno JM. Association of Physician Specialty with Hospice Referral for Hospitalized Nursing Home Patients with Advanced Dementia. J Am Geriatr Soc 2017; 65:1784-1788. [PMID: 28369754 DOI: 10.1111/jgs.14888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Hospitalists hospice referral patterns have been unstudied. This study aims to examine hospice referral rates by attending type for hospitalized nursing home (NH) residents with advanced cognitive impairment (ACI) at the time of discharge between 2000 and 2010. DESIGN Retrospective cohort study. PARTICIPANTS Hospitalized NH residents age ≥66 drawn from the 20% sample of Medicare beneficiaries with ACI, 4 or more activities of daily living (ADL) impairments on last minimum data set (MDS) assessment completed within 120 days of admission (n = 128,989). MEASUREMENTS Hospice referral was defined as referral to hospice within 1 day after hospital discharge. Attending physician type was determined by Part B physician billing for 100% of the billings during that admission. Continuity of care was defined as the hospital physician also billing for an outpatient visit within 120 days of that hospital admission. Number of ADL impairments, cognitive measures, pre-admission illnesses and illness severity were derived from the MDS. RESULTS Of the 105,329 hospitalized patients with ACI that survived to discharge (72.3% white, 30.6% male), the hospice referral rate at the time of hospital discharge increased from 2.8% in 2000 to 11.2% in 2010. Using a multivariate, hospital fixed effects model examining changes in the distribution of inpatient attending physicians, hospitalists compared to generalist physicians were more likely to refer these patients to hospice at discharge (AOR 1.17, 95% CI 1.09-1.26). Continuity of physician care from the outpatient setting to the hospital was associated with lower hospice referral (AOR 0.78, 95% CI 0.73-0.85). CONCLUSION Hospice referrals for NH-dwelling persons with ACI admitted to the hospital increased between 2000 and 2011 and disproportionately so when the attending physician was a hospitalist.
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Affiliation(s)
- Claire K Ankuda
- Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, Michigan
| | - Susan L Mitchell
- Hebrew Senior Life, Institute for Aging Research, Boston, Massachusetts
| | - Pedro Gozalo
- Health Services, Policy, and Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Vince Mor
- Health Services, Policy, and Practice, Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island.,Veterans Administration Medical Center, Providence, Rhode Island
| | - David Meltzer
- Section of Hospital Medicine, University of Chicago, Chicago, Illinois
| | - Joan M Teno
- Division of Gerontology and Geriatric Medicine, Department of Medicine, Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
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Schluter PJ, Ahuriri-Driscoll A, Anderson TJ, Beere P, Brown J, Dalrymple-Alford J, David T, Davidson A, Gillon DA, Hirdes J, Keeling S, Kingham S, Lacey C, Menclova AK, Millar N, Mor V, Jamieson HA. Comprehensive clinical assessment of home-based older persons within New Zealand: an epidemiological profile of a national cross-section. Aust N Z J Public Health 2016; 40:349-55. [DOI: 10.1111/1753-6405.12525] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/01/2015] [Accepted: 12/01/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Philip J. Schluter
- School of Health Sciences; University of Canterbury; New Zealand
- School of Nursing, Midwifery and Social Work; The University of Queensland
| | | | - Tim J. Anderson
- Department of Medicine; University of Otago; New Zealand
- New Zealand Brain Research Institute
| | - Paul Beere
- GeoHealth Laboratory; University of Canterbury; New Zealand
| | - Jennifer Brown
- Department of Mathematics and Statistics; University of Canterbury; New Zealand
| | - John Dalrymple-Alford
- New Zealand Brain Research Institute
- Department of Psychology; University of Canterbury; New Zealand
| | - Timothy David
- UC High Performance Computing; University of Canterbury; New Zealand
| | | | - Deborah A. Gillon
- Centre for Postgraduate Nursing Studies; University of Otago; New Zealand
| | - John Hirdes
- School of Public Health and Health Systems; University of Waterloo; Ontario Canada
| | - Sally Keeling
- Department of Medicine; University of Otago; New Zealand
| | - Simon Kingham
- GeoHealth Laboratory; University of Canterbury; New Zealand
- GeoHealth Laboratory; University of Canterbury; New Zealand
| | - Cameron Lacey
- Māori/Indigenous Health Institute (MIHI); University of Otago; New Zealand
- Department of Psychological Medicine; University of Otago; New Zealand
| | - Andrea K. Menclova
- Department of Economics and Finance; University of Canterbury; New Zealand
| | | | - Vince Mor
- School of Public Health; Brown University; Rhode Island USA
| | - Hamish A. Jamieson
- Department of Medicine; University of Otago; New Zealand
- Canterbury District Health Board; New Zealand
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Affiliation(s)
- V Mor
- Brown University, Center for Health Care Research, Providence, R.I
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Affiliation(s)
- V Mor
- Brown University, Center for Health Care Research, Providence, R.I
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Tuya Fulton A, Gozalo P, Mitchell SL, Mor V, Teno JM. Intensive care utilization among nursing home residents with advanced cognitive and severe functional impairment. J Palliat Med 2014; 17:313-7. [PMID: 24490881 PMCID: PMC3952520 DOI: 10.1089/jpm.2013.0509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Dementia is a progressive terminal illness which requires decisions around aggressiveness of care. OBJECTIVE The study objective was to examine the rate of intensive care unit (ICU) utilization and its regional variation among persons with both advanced cognitive and severe functional impairment. METHODS We utilized the Minimum Data Set (MDS) to identify a cohort of decedents between 2000 and 2007 who (1) were in a nursing home (NH) 120 days prior to death and (2) had an MDS assessment indicating advanced cognitive and functional impairment as identified by cognitive performance scale (CPS) ≥5 and total dependence or extensive assistance in seven activities of daily living (ADLs). ICU utilization in the last 30 days of life was determined from Medicare claims files. A multivariate logistic regression model examined the likelihood of ICU admission in 2007 versus 2000 adjusting for sociodemographics, orders to limit life sustaining treatment, and health status. RESULTS Among 474,829 Medicare NH residents with advanced cognitive impairment followed during 2000-2007, we observed an increase in ICU utilization from 6.1% in 2000 to 9.5% in 2007. After adjustment for sociodemographic characteristics, orders to limit life sustaining treatment, and measures of health status, the likelihood of a resident being admitted to an ICU was higher in 2007 compared to 2000 (adjusted odds ratio [OR] 1.71, 95% CI 1.60-1.81). Additionally, substantial regional variation was noted in ICU utilization, from 0.82% in Montana to 22% in the District of Columbia. CONCLUSIONS Even among patients with advanced cognitive and functional impairment, ICU utilization in the last 30 days increased and varied by geographic region.
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Affiliation(s)
- Ana Tuya Fulton
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Butler Hospital, Providence, Rhode Island
| | - Pedro Gozalo
- Department of Health Services, Policy, and Practice, Brown University Program in Public Health, Brown University, Providence, Rhode Island
| | - Susan L. Mitchell
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
| | - Vince Mor
- Department of Health Services, Policy, and Practice, Brown University Program in Public Health, Brown University, Providence, Rhode Island
| | - Joan M. Teno
- Department of Health Services, Policy, and Practice, Brown University Program in Public Health, Brown University, Providence, Rhode Island
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Weech-Maldonado R, Mor V, Oluwole A. Nursing home costs and quality of care: is there a tradeoff? Expert Rev Pharmacoecon Outcomes Res 2014; 4:99-110. [DOI: 10.1586/14737167.4.1.99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shawat E, Mor V, Oakes L, Fleger Y, Pint CL, Nessim GD. What is below the support layer affects carbon nanotube growth: an iron catalyst reservoir yields taller nanotube carpets. Nanoscale 2014; 6:1545-1551. [PMID: 24323364 DOI: 10.1039/c3nr05240k] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Here we demonstrate an approach to enhance the growth of vertically aligned carbon nanotubes (CNTs) by including a catalyst reservoir underneath the thin-film alumina catalyst underlayer. This reservoir led to enhanced CNT growth due to the migration of catalytic material from below the underlayer up to the surface through alumina pinholes during processing. This led to the formation of large Fe particles, which in turn influenced the morphology evolution of the catalytic iron surface layer through Ostwald ripening. With inclusion of this catalyst reservoir, we observed CNT growth up to 100% taller than that observed without the catalyst reservoir consistently across a wide range of annealing and growth durations. Imaging studies of catalyst layers both for different annealing times and for different alumina support layer thicknesses demonstrate that the surface exposure of metal from the reservoir leads to an active population of smaller catalyst particles upon annealing as opposed to a bimodal catalyst size distribution that appears without inclusion of a reservoir. Overall, the mechanism for growth enhancement we present here demonstrates a new route to engineering efficient catalyst structures to overcome the limitations of CNT growth processes.
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Affiliation(s)
- E Shawat
- Department of Chemistry and Institute for Nanotechnology, Bar-Ilan University, Ramat Gan, 52900, Israel.
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Abstract
OBJECTIVES To describe the extent to which hospitalized nursing home (NH) residents with advanced dementia were admitted to a skilled nursing facility (SNF) after a qualifying hospitalization and to identify resident and nursing home characteristics associated with a greater likelihood of SNF admissions. DESIGN Cohort study using data from the Minimum Data Set, Medicare claims, and the On-line Survey Certification of Automated Records. SETTING United States, 2000-2006. PARTICIPANTS Nursing home residents with advanced dementia aged 65 and older with a 3-day hospitalization (N = 4,177). MEASUREMENTS The likelihood of SNF admission after hospitalization was calculated. Resident and nursing home factors associated with SNF admission were identified using hierarchical multivariable logistic regression. RESULTS Sixty-one percent of residents with advanced dementia were admitted to a SNF after their hospitalization. Percutaneous endoscopic gastrostomy (PEG) tube placement during hospitalization was strongly associated with SNF admission (adjusted odds ratio (AOR) = 2.31, 95% confidence interval (CI) = 1.85-2.88), as was better functional status (AOR = 1.21, 95% CI = 1.05-1.38). The presence of diabetes mellitus was associated with lower likelihood of SNF admission (AOR = 0.85, 95% CI = 0.73-0.99). Facility features significantly associated with SNF admission included more than 100 beds (AOR = 1.25, 95% CI = 1.07-1.46), being part of a chain (AOR = 1.31, 95% CI = 1.14-1.50), urban location (AOR = 1.21, 95% CI = 1.03-1.41), and for-profit status (AOR = 1.28, 95% CI = 1.09-1.51). CONCLUSION The majority of nursing home residents with advanced dementia are admitted to SNFs after a qualifying hospitalization. SNF admission is strongly associated with PEG tube insertion during hospitalization and with nursing home factors. Efforts to optimize appropriate use of SNF services in individuals with advanced dementia should focus on these factors.
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Affiliation(s)
- Jane L. Givens
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA
- Hebrew SeniorLife Institute for Aging Research, Boston, MA
| | - Susan L. Mitchell
- Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA
- Hebrew SeniorLife Institute for Aging Research, Boston, MA
| | - Sylvia Kuo
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Pedro Gozalo
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Vince Mor
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Joan Teno
- Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
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Leland NE, Teno JM, Gozalo P, Bynum J, Mor V. Decision making and outcomes of a hospice patient hospitalized with a hip fracture. J Pain Symptom Manage 2012; 44:458-65. [PMID: 22727255 PMCID: PMC3432712 DOI: 10.1016/j.jpainsymman.2011.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 09/23/2011] [Accepted: 10/05/2011] [Indexed: 12/21/2022]
Abstract
CONTEXT Hospice patients are at risk for falls and hip fracture with little clinical information to guide clinical decision making. OBJECTIVES To examine whether surgery is done and survival of hip fracture surgery among persons receiving hospice services. METHODS This was an observational cohort study from 1999 to 2007 of Medicare hospice beneficiaries aged 75 years and older with incident hip fracture. We studied outcomes among hospice beneficiaries who did and did not have surgical fracture repair. Main outcomes included the trends in the proportion of those undergoing surgery, the site of death, and six-month survival. RESULTS Between 1999 and 2007, approximately 1% (n=14,400) of patients aged 75 years and older admitted with a diagnosis of their first hip fracture were receiving hospice services in the 30 days before that admission and 83.4% underwent surgery. Among patients on hospice at the time of the hip fracture, 8.8% died during the initial hospitalization and an additional two-thirds died within the first six months on hospice. The median survival from hospital admission was 25.9 days for those forgoing surgery compared with 117 days for those who had surgery, adjusted for age, race, and other covariates (P<0.001). CONCLUSION Despite being on hospice services, the majority underwent surgery with improved survival. Sixty-six percent of all individuals on hospice at the time of the fracture died in the first six months, with the majority returning to hospice services.
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Affiliation(s)
- Natalie E Leland
- Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, and Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
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Abstract
OBJECTIVES To examine the relationship between nursing home (NH) organizational characteristics and falls in newly admitted NH residents. DESIGN Observational cross-sectional study from January 1, 2006, to December 31, 2006. SETTING NHs in the United States in 2006. PARTICIPANTS Individuals (n = 230,730) admitted to a NH in 2006 without a prior NH stay and with a follow-up Minimum Data Set (MDS) assessment completed 30 days or more after admission. MEASUREMENTS The relationship between experiencing a fall noted on the MDS assessment and NH characteristics (e.g., staffing, profit and chain status, religious affiliation, hospital-based facility status, number of beds, presence of a special care unit, funding) was examined, adjusting for NH resident characteristics. RESULTS Twenty-one percent of this cohort (n = 47,750) had experienced at least one fall in the NH at the time of the MDS assessment, which was completed for newly admitted NH residents who had at least a 30-day stay. NHs with higher certified nursing assistant (CNA) staffing had lower rates of falls (adjusted odds ratio = 0.97, 95% confidence interval = 0.95-0.99). CONCLUSION For newly admitted NH residents, NHs with higher CNA staffing had a lower fall rate. In an effort to maximize fall prevention efforts, further research is needed to understand the relationship between CNA staffing and falls in this NH population.
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Affiliation(s)
- Natalie E Leland
- Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles, California 90089, USA.
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Abstract
OBJECTIVE To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays. DATA SOURCES Online Survey of Certification and Reporting (OSCAR) data for 202 free-standing NHs, Medicare Denominator, claims (parts A and B), and MDS assessments for 60,984 people who were present in one of these NHs in 2006. METHODS The algorithm creating the RHF is outlined and the RHF for the study data are used to describe place of death. The identification of residents in NHs is compared with the reports in OSCAR and part B claims. PRINCIPAL FINDINGS The RHF correctly identified 84.8 percent of part B claims with place-of-service in NH, and it identified 18.3 less residents on average than reported in the OSCAR on the day of the survey. The RHF indicated that 17.5 percent non-Medicare NH decedents were transferred to the hospital to die versus 45.6 percent skilled nursing facility decedents. CONCLUSIONS The population-based design of the RHF makes it possible to conduct policy-relevant research to examine the variation in the rate and type of health care transitions across the United States.
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Affiliation(s)
- Orna Intrator
- Center for Gerontology and Health Care Research, Brown University, PO Box G-S121-6, Providence, RI 02912, USA.
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Resnik L, Liu D, Mor V, Hart DL. Predictors of physical therapy clinic performance in the treatment of patients with low back pain syndromes. Phys Ther 2008; 88:989-1004. [PMID: 18689610 PMCID: PMC2527215 DOI: 10.2522/ptj.20070110] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 06/09/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Little is known about organizational and service delivery factors related to quality of care in physical therapy. This study sought to identify characteristics related to differences in practice outcomes and service utilization. SUBJECTS The sample comprised 114 outpatient clinics and 1,058 therapists who treated 16,281 patients with low back pain syndromes during the period 2000-2001. Clinics participated with the Focus on Therapeutic Outcomes, Inc (FOTO) database. METHODS Hierarchical linear models were used to risk adjust treatment outcomes and number of visits per treatment episode. Aggregated residual scores from these models were used to classify each clinic into 1 of 3 categories in each of 3 types of performance groups: (1) effectiveness, (2) utilization, and (3) overall performance (ie, composite measure of effectiveness and utilization). Relationships between clinic classification and the following independent variables were examined by multinomial logistic regression: years of therapist experience, number of physical therapists, ratio of physical therapists to physical therapist assistants, proportion of patients with low back pain syndromes, number of new patients per physical therapist per month, utilization of physical therapist assistants, and setting. RESULTS Clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified in the low utilization group compared with the high utilization group, and 12.4 times more likely to be classified in the best performance group compared with the worst performance group. Serving a higher proportion of patients with low back pain syndromes was associated with an increased likelihood of being classified in the lowest or middle group. Years of physical therapist experience was inversely associated with being classified in the middle utilization group compared with the highest utilization group. DISCUSSION AND CONCLUSION These findings suggest that, in the treatment of patients with low back pain syndromes, clinics that are low utilizers of physical therapist assistants are more likely to provide superior care (ie, better patient outcomes and lower service use).
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Affiliation(s)
- Linda Resnik
- Providence VA Medical Center, Department of Community Health, Brown University, 2 Stimson Ave, Providence, RI 02912, USA.
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Mor V. Malignant disease and the elderly. Ciba Found Symp 2007; 134:160-76. [PMID: 3282836 DOI: 10.1002/9780470513583.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Most cancers are diseases of the ageing. Approximately 50% of all cancers occur among those over 65 and nearly 60% of all cancer deaths occur among the elderly. The cumulative risk of acquiring cancer among those aged 65-85 is 17% in females and 23% in males. Cancer incidence increases steadily as a function of age, reaching 23 per 1000 population among those aged 85 and older. Recent estimates of age-specific cancer prevalence rates for women over 70 were 106 per 1000 population and were 118 per 1000 population among men over 70. The rapidly shifting age distribution in most industrialized nations, including the growth of the 'old-old', means that the actual number of older people with cancer will increase at least in proportion to the ageing of the population. This trend will have an impact on the health-care system and may affect social norms regarding the treatment of elderly cancer patients. This paper reviews these trends and presents data from a series of research projects and the related literature to examine how older people respond to cancer symptoms and treatment and whether the treatment received by aged cancer patients differs from that given to younger patients. The relationship between age and stage of disease at presentation is explored, together with the manner in which older cancer patients' disease is identified, the 'aggressiveness' of treatment pursued, and patients' responses to those treatments.
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Affiliation(s)
- V Mor
- Center for Long Term Care Gerontology, Brown University, Providence, Rhode Island 02912
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Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Serv Res 2007; 42:1651-71. [PMID: 17610442 PMCID: PMC1955269 DOI: 10.1111/j.1475-6773.2006.00670.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. DATA SOURCES/STUDY SETTING Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. STUDY DESIGN Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. PRINCIPAL FINDINGS Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). CONCLUSIONS State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-ST2, Providence, RI 02912, USA
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Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies. Health Serv Res 2007. [PMID: 17610442 DOI: 10.1111/j.1475‐6773.2006.00670.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. DATA SOURCES/STUDY SETTING Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. STUDY DESIGN Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. PRINCIPAL FINDINGS Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). CONCLUSIONS State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.
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Affiliation(s)
- Orna Intrator
- Brown University, Box G-ST2, Providence, RI 02912, USA
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