Hongdao Meng

Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs

PURPOSE OF THE STUDY To examine the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs). DESIGN AND METHODS The present study used a cross-sectional design. We combined two data sources: NH facility-level data (including characteristics of the facility and its residents) and county-level market characteristics (including HCBS waiver expenditures) for 653 Florida NHs in 2007. Low-care was defined as residents who require no physical assistance in any of the 4 late-loss activities of daily living (bed mobility, toileting, transferring, and eating). We estimated a 2-level hierarchical linear model (HLM) to examine the relationship between Medicaid HCBS waiver expenditures and the prevalence of low-care residents while accounting for resident assessment, facility-, and county-level covariates. RESULTS All Florida counties offered 2 statewide waivers, and 33 counties offered one or more of the 4 regional Medicaid HCBS waivers in 2007. Per-month beneficiary expenditures ranged from

Chronic Fatigue Self- Management in Primary Care: A Randomized Trial

755 to

Prevalence and predictors of fatigue in middle-aged and older adults: evidence from the health and retirement study.

1,778. The average Florida NH had 120 beds, and 8.0% of its residents were classified as low-care. Results from the HLM model showed that a

Self-reported versus measured height and weight in the health and retirement study.

10,000 increase in per-enrollee HCBS waiver expenditures was associated with a 3.5 percentage point reduction in low-care resident prevalence (p = .03). IMPLICATIONS The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.

Facility characteristics associated with the use of electronic health records in residential care facilities

Objective To assess the efficacy of brief fatigue self-management (FSM) for medically unexplained chronic fatigue (UCF) and chronic fatigue syndrome (CFS) in primary care. Methods A randomized controlled design was used wherein 111 patients with UCF or CFS were randomly assigned to two sessions of FSM, two sessions of symptom monitoring support (attention control; AC), or a usual care control condition (UC). Participants were assessed at baseline and at 3 and 12 months after treatment. The primary outcome, the Fatigue Severity Scale, measured fatigue impact on functioning. Analysis was by intention to treat (multiple imputation) and also by per protocol. Results A group × time interaction across the 15-month trial showed significantly greater reductions in fatigue impact in the FSM group in comparison with the AC group (p < .023) and the UC group (p < .013). Medium effect sizes for reduced fatigue impact in the FSM group were found in comparison with the AC group (d = 0.46) and the UC group (d = 0.40). The per-protocol analysis revealed large effect sizes for the same comparisons. Clinically significant decreases in fatigue impact were found for 53% of participants in the FSM condition, 14% in the AC condition, and 17% in the UC condition. Dropout rates at the 12-month follow-up were high (42%–53%), perhaps attributable to the burden of monthly telephone calls to assess health care use. Conclusion A brief self-management intervention for patients with UCF or CFS seemed to be clinically effective for reducing the impact of fatigue on functioning. Trial Registration clinicaltrials.gov Identifier: NCT00997451.

Cost-effectiveness of chronic fatigue self-management versus usual care: a pilot randomized controlled trial

than 11 out of 15 and a MMSE score of 23 or less out of 30 (correlation coefficient 5 .783). In a study of a two-questions screening test for depression in patients without cognitive impairment (defined as a MMSE score 26), a score of 1 or greater had a sensitivity of 84%, a specificity of 61%, and a NPV of 95% compared with a 15-item Geriatric Depression Scale (GDS-15) score of 5 or greater. To assess functional status, the Older Americans Resources and Services (OARS) questionnaire, with a score ranging from 0 to 28 and taking approximately 5 minutes to administer is the most used in North America. Although the cutoff is not clearly determined, each point under the maximum score indicates a functional disability that must be taken into account for further interventions or advises. The one-leg balance test is a short and simple test during which the patient has just to be able to stand up. The inability to perform this task doubles the risk for an injurious fall during the next 3 years. Concerning malnutrition, there is no validated test that can be routinely used in the ED, and the measurement of body mass index, frequently included in nutritional scores, is difficult to perform in the ED. It is also critical to take advantage of the ED visit to review and improve the medication list to reduce adverse drug events. The Beer’s criteria are a widely accepted list that can help to identify potentially inappropriate medication in older patients and can be used to simplify treatments. In conclusion, older patients admitted to the ED should be screened for risk of adverse outcomes. In patients at high risk of adverse outcomes, the CGA should be administered with brief tools validated in the ED. This two-step intervention has been shown to decrease the rate of functional decline, readmission, and institutionalization. Further research is needed to validate this approach in different populations, such as in Europe or Asia.

Predictors of Long‐Term Nursing Home Placement Under Competing Risk: Evidence from the Health and Retirement Study

Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. This research was supported by Grants K07CA125586 (TWY), R21CA131643 and K08AG021631 (JMN), and R01CA81379 (ABN) from the National Institutes of Health, National Cancer Institute and National Institute on Aging. These grant funds are not related to products, technology, or methodologies involved in this manuscript submission. Author Contributions: Study concept and design: Laud, Nattinger, Yen. Acquisition of subjects and data: Nattinger, Sparapani. Analysis and interpretation of data: Guo, Sparapani, Laud, Nattinger, Neuner, Yen. Preparation of manuscript: Laud, Nattinger, Neuner, Sparapani, Yen. Sponsor’s Role: None.

Hospice Use and Public Expenditures at the End of Life in Assisted Living Residents in a Florida Medicaid Waiver Program

The integration of electronic health records (EHRs) across care settings including residential care facilities (RCFs) promises to reduce medical errors and improve coordination of services. Using data from the 2010 National Survey of Residential Care Facilities (n=2302), this study examines the association between facility structural characteristics and the use of EHRs in RCFs. Findings indicate that in 2010, only 3% of RCFs nationwide were using an EHR. However, 55% of RCFs reported using a computerized system for one or more (but not all) of the functionalities defined by a basic EHR. Ownership, chain membership, staffing levels, and facility size were significantly associated with the use of one or more core EHR functionalities. These findings suggest that facility characteristics may play an important role in the adoption of EHRs in RCFs.

Changes in weight among U.S. adults aged 70 and over, 1993 to 2002

BackgroundFatigue is a common yet difficult to treat condition in primary care. The objective of this study is to evaluate the cost-effectiveness of a brief cognitive behavioral therapy (CBT) based fatigue self-management (FSM) intervention as compared to usual care among patients with chronic fatigue in primary care.MethodsAn economic evaluation alongside of a parallel randomized controlled study design was used. Computer-generated variable-sized block randomization plan was used to assign patients into treatment groups and data collection staff were blinded to group assignments. Patients aged between 18 and 65 years with at least six months of persistent fatigue and no medical or psychiatric exclusions were enrolled from a large primary care practice in Stony Brook, New York. The FSM group (n = 37) received two sessions of a nurse-delivered, fatigue self-management protocol and a self-help book and the usual care group (n = 36) received regular medical care. The effectiveness measure was the Fatigue Severity Scale and the cost measure was total health care expenditures derived from monthly health services use diaries during follow-up. A societal perspective was adopted and bootstrapped incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were calculated as measures of cost-effectiveness.ResultsThe ICER for FSM was -