Frank W. Porell

Vulnerable populations at risk of potentially avoidable hospitalizations: The case of nursing home residents with Alzheimer's disease:

This study explores whether nursing home residents with Alzheimers disease and related dementias (ADRD) are affected differently by facility-level risk factors of ambulatory care-sensitive (ACS) conditions, a measure of timely access to medical care. Three years of quarterly Medicaid reimbursement data from over 525 Massachusetts nursing homes were linked with four years of Medical Provider Analysis and Review hospital claims data and facility-level attribute data to investigate whether facility effects differed by resident ADRD status. The findings suggest that nursing home residents with ADRD are more likely to be hospitalized for certain ACS conditions, including gastroenteritis and kidney/urinary tract infections. Availability of increased registered nurse staffing levels and on-site nurse practitioners appears to attenuate this risk. Although findings suggest that ACS hospitalization measures may represent a useful approach to monitoring nursing home care, additional effort is needed to understand the extent to which severity of illness and/or comorbidities affect the measurement of these hospitalizations.

Predictors of Home Healthcare Nurse Retention

PURPOSE To examine the level of job satisfaction and test a theoretical model of the direct and indirect effects of job satisfaction, and individual nurse and agency characteristics, on intent to stay and retention for home healthcare nurses. DESIGN A descriptive correlation study of home healthcare nurses in six New England states. METHODS Home healthcare nurse job satisfaction self-report data was collected with the HHNJS survey questionnaire & Retention Survey Questionnaire. FINDINGS Based on a structural equation model, job tenure and job satisfaction were the strongest predictors of nurse retention. CONCLUSIONS Understanding the variables associated with home healthcare nurse retention can help agencies retain nurses in a time of severe nurse shortages and increased patient demand. CLINICAL RELEVANCE Predicted nursing shortages and increasing demand have made the retention of experienced, qualified nursing staff essential to assure access to high-quality home healthcare services in the future.

Job Characteristics and Leisure Physical Activity

Objectives:This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relatingwork and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically. Methods:Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one’s job. Results:Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise. Discussion:The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

Hospital Choice Models: A Review and Assessment of their Utility for Policy Impact Analysis

The changing competitive hospital environment and recent greater availability of patient origin data have stimulated an increased research interest in factors influencing the reason patients are admitted to one hospital over another. Hospital marketers and managed care planners seek information for attracting patients and for negotiating hospital provider networks, respectively. Hospital choice models can help regulators make better informed assessments of the welfare implications of proposed mergers or closures. The literature shows the development of increasingly sophisticated models and techniques for analysis of hospital choice. Recent studies have also related the findings to health policy issues. This review summarizes the historical developments and the cumulative knowledge gained about hospital choice to date, identifies some key issues in need of greater attention, and assesses the potential strengths and limitations of contemporary choice models for making policy impact assessments.

The Association Between Low Vision and Function

Objective: This study considers the relationship between low vision and function, specifically exploring whether vision loss is differentially associated with activities of daily living (ADL) versus instrumental activities of daily living (IADL) disability. Methods: Guided by the World Health Organizations International Classification of Functioning, Disability, and Health framework, multinomial logistic regression analyses were performed for IADL and ADL on a sample of 9,115 adults aged 65 years and above from the 1998 Health and Retirement study. Results: The data supports the fact that ADL and IADL disabilities are associated with vision loss, and there is a differential relationship among functions, with IADLs being more challenging and requiring better visual abilities. Discussion: The findings provide evidence that ADL and IADLs require different skills and are associated differently depending on numerous variables. As the incidence of people living with vision loss is increasing to epidemic proportions due to an aging population, understanding the relationship between vision and participation in meaningful activities has important implications.

Regional differences in functional status among the aged

This study investigated regional differences in functional status among aged Medicare beneficiaries in the United States, and the degree to which population risk factors and certain geographic/environmental attributes of communities accounted for the regional differences. Four years of the Medicare Current Beneficiary Survey (1992-1995) were pooled together yielding 37,150 person-year observations of functional status for a sample of aged Medicare beneficiaries residing in the community or nursing homes. Multinomial logit models, estimated on a four-category functional status scale, produced strong empirical evidence of substantial regional differences in the prevalence of functional independence, functional limitations, IADL limitations, and ADL limitations, that could not be attributed to regional population composition, socio-demographic factors, lifestyle characteristics, and chronic medical conditions. Although such population risk factors accounted for much of the regional variations in functional status among older men, the notably higher prevalence of IADL and ADL limitations among older women residing in the Deep South could not be similarly attributed to such risk factors. Rather, the empirical results suggest that a significant portion of the harmful effects associated with residence in the Deep South among older women may be attributed to a higher prevalence of residence in counties characterized by lower population density and/or higher poverty concentration.

Discretionary Hospitalization of Nursing Home Residents With and Without Alzheimer’s Disease: A Multilevel Analysis

This study analyzes facility variations in hospital admission rates of nursing home (NH) residents with and without Alzheimer’s disease (AD) or related dementia with the aim of better understanding how facility-level contextual factors differentially affect hospitalization risks. Method: The sample population consists of 19,217 and 18,399 Medicaid residents with and without AD, respectively, from 546 NHs in Massachusetts between 1991 and 1993. Hospital use is measured as annual nonpsychiatric discretionary hospital admissions to short-term general hospitals. Multilevel estimation methods are used to obtain facility and market area parameter estimates. Results: There was greater interfacility variation in discretionary hospital admission rates of AD residents than residents without AD, particularly among more vulnerable subgroups of AD residents. Discussion: The findings underscore the importance of licensed nursing personnel in reducing discretionary hospitalizations among NH residents with AD.

A Comparison of Ambulatory Care-Sensitive Hospital Discharge Rates for Medicaid HMO Enrollees and Nonenrollees

With an increasing volume of Medicaid recipient enrollees in managed care, many states are developing tools for monitoring service quality and access of Medicaid recipients. This article explores the use of ambulatory care-sensitive (ACS) hospital discharge rates as a simple, practical indicator tool for monitoring the access of Medicaid health maintenance organization (HMO) enrollees through an empirical application in Massachusetts in 1995. Although unadjusted hospital discharge rates were lower, Medicaid HMO enrollees had higher age-gender-race adjusted total and ACS hospital discharge rates than Medicaid recipients enrolled in a primary care case management program under fee-for-service reimbursement. Higher HMO discharge rates for the specific ACS conditions of asthma and dehydration were suggestive of potential HMO access problems.

Do Older Adults Anticipate Relocating? The Relationship Between Housing Relocation Expectations and Falls

The relationship between the occurrence of falls and the expectations older adults have about making future residential moves is examined in this research. Data from the 2002 Health and Retirement Study (HRS) are used to analyze self-reported probabilities of moving among a nationally representative sample of noninstitutionalized adults aged 65 and older. The results show that falls were predictive of anticipation of housing relocation as indicated by more than 50% reported probability of moving within the next 2 years. The results suggest that consideration of housing relocation is greater among older adults who experience tangible events indicative of a trajectory of deteriorating health.

Disability Outcomes of Older Medicare HMO Enrollees and Fee-for-Service Medicare Beneficiaries

OBJECTIVES: To investigate whether older Medicare beneficiaries enrolled in Medicare risk health maintenance organizations (HMOs) have different rates of disablement than fee‐for‐service (FFS) beneficiaries.