Mary W. Carter

Emerging services for community-based long-term care in urban China: a systematic analysis of Shanghai's community-based agencies.

Abstract Chinas rapid economic reforms, coupled with the changes in age composition of the demographic structure, have greatly affected the traditional family support system. In response to these changes, efforts to develop new models of community-based long-term care (CBLTC) for elders in China have received growing attention. This paper provides a systematic analysis of the current status of emerging CBLTC systems in Shanghai, China. It covers several domains of the system: service delivery, workforce, financing, and quality of care management. Several main issues involved in the development of the emerging system are addressed, and relevant policy implications are presented in the paper.

Factors Associated with Ambulatory Care—Sensitive Hospitalizations among Nursing Home Residents

Objectives: This study examined patient-level, facility-level, and area market-level factors affecting ambulatory care-sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home residents has not been employed. Methods: Three years of quarterly Medicaid reimbursement data from more than 500 nursing homes were linked to 4 years of Medicare Provider Analysis and Review hospital claims data, nursing facility attribute data, and Area Resource File data to investigate the relative contribution of patient-, facility-, and market-level risk factors to ACSH among nursing home residents. Results: Logistic regression results indicate that facility-level factors and nursing home quality-of-care indicators significantly contribute to the risk of ACSH. Discussion: Findings underscore the need for continuing efforts to improve quality-of-care practices in nursing homes, particularly with respect to associations between quality-of-care indicators and facility structural/organizational characteristics with ACSHs.

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.

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.

The Effect of Direct-to-Consumer Advertising on Prescription Drug Use by Older Adults

Background and objectiveAlthough older adults are frequent consumers of prescription drugs and increasingly the intended audience of direct-to-consumer advertising (DTCA) marketing efforts, little is known about the effect of DTCA on older adults’ prescription drug-seeking behaviour. In response, the objective of this study is to examine factors associated with requesting a prescription drug from a physician following exposure to DTCA among older adults, and whether the drug or other medical treatment was prescribed during the encounter.MethodsA secondary data analysis of the “Public Health Impact of Direct-to-Consumer Advertising of Prescription Drugs”, a data set publicly available through the Inter-university Consortium for Political and Social Research (ICPSR 3687), was conducted. For the purposes of this study, only those respondents who indicated that they had been exposed to DTCA (n = 2601) were included in the study sample. Using a two-step weighted logistic regression approach, separate models were estimated to examine first, whether a request for the advertised drug was made following exposure to DTCA and secondly, the outcomes of any patient-physician encounters that occurred following exposure to DTCA.ResultsDescriptive analysis of the outcome variables revealed that, among respondents exposed to DTCA, 31% (n = 801) requested a prescription drug from their physician. Approximately 5% of those who made a request were ≥75 years of age. Among respondents requesting a prescription drug, 69% (n = 556) received a prescription in response to their request, of whom, approximately 5% were ≥75 years of age. Multivariate findings suggest that although adults ≥75 years of age are less likely to request a prescription drug following exposure to DTCA (odds ratio [OR] = 0.58; p = 0.032), when they do approach their physicians, they are more likely to receive recommendations for further treatment, with ORs indicating a 250% (OR = 3.507; p = 0.002) increase in the odds of further referral among adults ≥75 years of age.ConclusionOverall, results from the study suggest that DTCA influences the patient-doctor relationship and prescription drug acquisition behaviour of patients; however, the nature of the effect of DTCA on older adults is complex. Because future cohorts of older adults may be more comfortable about requesting prescription drugs and the consumer-driven approach to obtaining medical care, understanding the impact of DTCA on older consumers represents an important area for further inquiry.

Principles of good care for long-term care facilities

BACKGROUND The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities aims to support and strengthen mental health services in the long-term care sector. The purpose of this paper is to identify broad principles that may underpin the drive towards meeting the mental health needs of residents of long-term care facilities and their families, as well as to enhance the overall delivery of residential care services. METHODS Principles of good care are extrapolated from an analysis of international consensus documents and existing guidelines and discussed in relation to the research and practice literature. RESULTS Although the attention to principles is limited, this review reveals an emerging consensus that: (1) residential care should be situated within a continuum of services which are accessible on the basis of need; (2) there should be an explicit focus on quality of care in long-term care facilities; and (3) quality of life for the residents of these facilities should be a primary objective. We take a broad perspective on the challenges associated with actualizing each of these principles, taking into consideration key issues for families, facilities, systems and societies. CONCLUSIONS Recommendations for practice, policy and advocacy to establish an internationally endorsed principles-based framework for the evolution and development of good mental health care within long-term care facilities are provided.

Characteristics and outcomes of injury-related ED visits among older adults☆

OBJECTIVES The objectives of this study were to examine the epidemiology of injury among older adults treated in emergency departments (EDs) and to explore the effect of advanced age and nursing home residence on associated outcomes. METHODS A secondary data analysis of a nationally representative sample from the National Hospital Ambulatory Care Survey was conducted using available sampling weights and data from the US Census Bureau. Weighted multivariate logistic regression was used to explore factors associated with injury outcomes, including hospitalization and receipt of potentially inappropriate medications. RESULTS Nearly 21 million injury-related ED patient visits were made by older adults during the study period. Nearly 10% of episodes were identified as adverse events, which increased hospitalization risk 3-fold. Potentially inappropriate medications were provided during nearly 12% of encounters. CONCLUSIONS Injury reductions among elders could be achieved by reducing adverse events, whereas quality could be improved by reducing potentially inappropriate medication use in the ED.

ED use by older adults attempting suicide

OBJECTIVE The objective of this study was to describe patterns of older adult patient visits to emergency departments (EDs) for self-harm and suicide-related injuries. METHODS A retrospective, secondary data analysis of the Nationwide Emergency Department Sample was conducted. Nationally representative estimates of patient visits by older adults attempting suicide were calculated using available sampling weights. Population estimates were calculated using estimates from the US Census Bureau. RESULTS Findings suggest that 22,444 ED patient visits were made by adults aged 65 years and older for suicide-related injuries, representing an estimated population rate of 63 ED patient visits per 100000 adults aged 65 years and older, with nearly half of all visits involving substance use. Total ED and hospital charges exceeded

Nursing home performance on select publicly reported quality indicators and resident risk of hospitalization: grappling with policy implications.

353.9 million. CONCLUSIONS Effort is needed to better integrate and deliver suicide screening and support services in the ED, while also connecting at-risk older adults with mental health services before and after the ED encounter.

The Effect of Sentinel Injury on Medicare Expenditures over Time

Abstract This study examines how resident risk of hospitalization varies in relation to facility performance on select quality indicators (QIs). Using a 15% sample, three years of Medicaid reimbursement data from over 525 nursing homes (NHs) were linked with four years of hospital claims data and facility-level data to investigate whether residents of NHs with worse (better) than expected performance on QIs experienced increased (decreased) risk of hospitalization. Logistic regression results indicate that variations in hospitalization risk among NH residents are explained in part by facility performance on QIs. Residents from NHs with more decubitus ulcers, with greater use of physical restraints, and with a higher than expected incidence of unexplained weight loss/gain experienced increased risk of hospitalization.