Frank Stetzer

Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.

Background:Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives:The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design:This study used a randomized controlled trial with three arms and longitudinal outcome measurement. Setting:Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. Methods:All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. Results:After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. Discussion:Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

Incidence of and risk factors for nosocomial bloodstream infections in adults in the United States, 2003.

BACKGROUND Although many studies have examined nosocomial bloodstream infection (BSI), US national estimates of incidence and case-fatality rates have seldom been reported. OBJECTIVE The purposes of this study were to generate US national estimates of the incidence and severity of nosocomial BSI and to identify risk factors for nosocomial BSI among adults hospitalized in the United States on the basis of a national probability sample. METHODS This cross-sectional study used the US Nationwide Inpatient Sample for the year 2003 to estimate the incidence and case-fatality rate associated with nosocomial BSI in the total US population. Cases of nosocomial BSI were defined by using 1 or more International Classification of Diseases, 9th Revision, Clinical Modification codes in the secondary field(s) that corresponded to BSIs that occurred at least 48 hours after admission. The comparison group consisted of all patients without BSI codes in their NIS records. Weighted data were used to generate US national estimates of nosocomial BSIs. Logistic regression was used to identify independent risk factors for nosocomial BSI. RESULTS The US national estimated incidence of nosocomial BSI was 21.6 cases per 1,000 admissions, while the estimated case-fatality rate was 20.6%. Seven of the 10 leading causes of hospital admissions associated with nosocomial BSI were infection related. We estimate that 541,081 patients would have acquired a nosocomial BSI in 2003, and of these, 111,427 would have died. The final multivariate model consisted of the following risk factors: central venous catheter use (odds ratio [OR], 4.76), other infections (OR, 4.61), receipt of mechanical ventilation (OR, 4.97), trauma (OR, 1.98), hemodialysis (OR, 4.83), and malnutrition (OR, 2.50). The total maximum rescaled R(2) was 0.22. CONCLUSIONS The Nationwide Inpatient Sample was useful for estimating national incidence and case-fatality rates, as well as examining independent predictors of nosocomial BSI.

Length of stay and charges associated with health care-acquired bloodstream infections

BACKGROUND Although many studies have examined outcomes of health care-associated bloodstream infections (HCABSIs), population-based estimates of length of stay (LOS) and costs have seldom been reported. OBJECTIVES Our objective was to generate US national estimates of LOS and costs associated with HCABSIs using the 2003 National Inpatient Sample (NIS). METHODS This study utilized a matched case-control design to estimate LOS and costs associated with HCABSIs based on the 2003 (NIS). A special set of ICD-9-CM codes was used to identify cases. A 1:1 matching procedure was used in which HCABSIs in patients were matched with uninfected patients based on age, sex, and admission diagnosis. We performed weighted analysis to construct population estimates and their standard deviations for LOS and total charges. RESULTS After applying the case finding criteria, 113,436 HCABSI cases were identified. The weighted mean LOS for HCABSIs cases was 16.0 days compared with 5.4 days for the control group (P < .001). The weighted mean total charges for patients with HCABSIs were

Aging in Place Versus Nursing Home Care: Comparison of Costs to Medicare and Medicaid

85,813 (

The Impact of Prenatal Care Coordination on Birth Outcomes

110,183 US in 2010) compared with

The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs.

22,821 (

Cost Analysis of a Home‐Based Nurse Care Coordination Program

29,302 US in 2010) for uninfected patients (P < .001). We estimated that, in 2003, HCABSIs potentially cost the US economy nearly

Medication regimens of frail older adults after discharge from home healthcare.

29 billion (

Comparing Aging in Place to Home Health Care: Impact of Nurse Care Coordination On Utilization and Costs.

37.24 billion US in 2010). CONCLUSION This study estimated the economic burden of HCABSIs on the US national economy. With some modifications, the annually published NIS data could be useful as a national surveillance tool for health care adverse events including HCABSIs.

Predictors of nonpharmacological and pharmacological treatments stopped and started among nursing home residents with dementia.

The objective of this study was to compare the community-based, long-term care program called Aging in Place (AIP) and nursing home care, in terms of cost to the Medicare and Medicaid programs. A retrospective cohort design was used in this study of 39 nursing home residents in the Midwest who were matched with 39 AIP participants. The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination. Controlling for high inpatient Medicare cost in the 6 months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were