Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.452
Filtrar
1.
BMC Geriatr ; 24(1): 214, 2024 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-38429700

RESUMO

BACKGROUND: At present, there are no consistent findings regarding the association between physical health loss and mental health in older adults. Some studies have shown that physical health loss is a risk factor for worsening of mental health. Other studies revealed that declining physical health does not worsen mental health. This study aimed to clarify whether the relationship between physical health loss and emotional distress varies with age in older inpatients post receiving acute care. METHODS: Data for this study were collected from 590 hospitalized patients aged ≥ 65 years immediately after their transfer from an acute care ward to a community-based integrated care ward. Emotional distress, post-acute care physical function, and cognitive function were assessed using established questionnaires and observations, whereas preadmission physical function was assessed by the family members of the patients. After conducting a one-way analysis of variance (ANOVA) and correlation analysis by age group for the main variables, a hierarchical multiple regression analysis was conducted with emotional distress as the dependent variable, physical function as the independent variable, age as the moderator variable, and cognitive and preadmission physical function as control variables. RESULTS: The mean GDS-15 score was found to be 6.7 ± 3.8. Emotional distress showed a significant negative correlation with physical function in younger age groups (65-79 and 80-84 years); however, no such association was found in older age groups (85-89, and ≥ 90 years). Age moderated the association between physical function and emotional distress. Poor physical function was associated with higher emotional distress in the younger patients; however, no such association was observed in the older patients. CONCLUSIONS: Age has a moderating effect on the relationship between physical health loss and increased emotional distress in older inpatients after acute care. It was suggested that even with the same degree of physical health loss, mental damage differed depending on age, with older patients experiencing less damage.


Assuntos
Angústia Psicológica , Cuidados Semi-Intensivos , Humanos , Idoso , Japão/epidemiologia , Emoções , Pacientes Internados
2.
Clin Geriatr Med ; 40(2): 321-331, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38521602

RESUMO

LGBTQ + older adults have a high likelihood of accessing nursing home care. This is due to several factors: limitations performing activities of daily living and instrumental activities of daily living, restricted support networks, social isolation, delay seeking assistance, limited economic resources, and dementia. Nursing home residents fear going in the closet, which can have adverse health effects. Cultivating an inclusive nursing home culture, including administration, staff, and residents, can help older LGBTQ + adults adjust and thrive in long-term care.


Assuntos
Assistência de Longa Duração , Minorias Sexuais e de Gênero , Humanos , Idoso , Atividades Cotidianas , Cuidados Semi-Intensivos , Casas de Saúde
4.
JAMA Health Forum ; 5(2): e235325, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38363561

RESUMO

Importance: Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM. Objective: To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes. Design, Setting, and Participants: This was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015 MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023. Exposures: Enrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM. Main Outcomes and Measures: Received care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number of days in the community during the 30 days after hospital discharge; and mortality. Results: The study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky. After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, -74.2 to -65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7 to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, -14.6 to -2.6) pp, and days in the community fell by 1.6 (95% CI, -2.9 to -0.3) days for Ohio public retirees compared with other Humana MA enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group. Conclusions and Relevance: The findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period.


Assuntos
Medicare Part C , Idoso , Humanos , Estados Unidos , Estudos de Coortes , Alta do Paciente , Cuidados Semi-Intensivos , Assistência ao Convalescente
5.
Arch Gerontol Geriatr ; 120: 105325, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38237375

RESUMO

OBJECTIVE: To examine the association between the de Morton Mobility Index (DEMMI) score on admission in geriatric patients and readmission and mortality within 30, 180, and 365 days after discharge, and discharge to a post-acute care facility. METHODS: A nationwide register-based cohort study including 23,941 geriatric in-patients aged ≥65 years admitted to a geriatric ward between 2014 and 2017 and included in the Danish National Database for Geriatrics. The DEMMI score was categorized into four subcategories: very low mobility (DEMMI=0-24), low mobility (DEMMI=27-39), moderately reduced mobility (DEMMI=41-57), and independent mobility (DEMMI=62-100). Patients were followed 30, 180 and 365 days after discharge for readmission and mortality. Their risk of being discharged to a post-acute care facility was examined. Adjusted hazard ratios (HRs) and odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. RESULTS: HRs for readmission within 30-days were 1.36 (1.24-1.48) for very low mobility, 1.30 (1.20-1.42) for low mobility and 1.17 (1.08-1.28) for moderately reduced compared with independent mobility. Similar results were seen for readmission within 180- and 365-days. For mortality, HR for 30-day mortality ranged from1.93 and 5.66, 180-day mortality between 1.62 and 3.19, and 365-day mortality between 1.54 and 2.81 compared with patients with independent mobility. OR for discharge to a post-acute care facility was 8.76 (7.29-10.53) for lowest compared with the highest DEMMI mobility subcategory. CONCLUSION: In geriatric in-patients, lower DEMMI scores on hospital admission are associated with increased rates of discharge to a post-acute care facility, and for readmission, and mortality within one year.


Assuntos
Alta do Paciente , Readmissão do Paciente , Idoso , Humanos , Estudos de Coortes , Cuidados Semi-Intensivos , Avaliação Geriátrica/métodos , Limitação da Mobilidade , Reprodutibilidade dos Testes
6.
Arch Gerontol Geriatr ; 119: 105323, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38171034

RESUMO

OBJECTIVES: This study aimed to evaluate the efficacy of adding ß-hydroxy-ß- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. MAIN OUTCOME MEASURES: The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. RESULTS: After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. CONCLUSIONS: Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.


Assuntos
Treinamento de Força , Sarcopenia , Valeratos , Humanos , Feminino , Idoso , Sarcopenia/terapia , Força da Mão , Cuidados Semi-Intensivos , Força Muscular/fisiologia , Método Duplo-Cego , Suplementos Nutricionais , Músculo Esquelético/fisiologia
7.
J Am Med Dir Assoc ; 25(1): 138-145.e6, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37913819

RESUMO

OBJECTIVES: Medications with a higher risk of harm or that are unlikely to be beneficial are used by nearly all older patients in home health care (HHC). The objective of this study was to understand stakeholders' perspectives on challenges in deprescribing these medications for post-acute HHC patients. DESIGN: Qualitative individual interviews were conducted with stakeholders involved with post-acute deprescribing. SETTING AND PARTICIPANT: Older HHC patients, HHC nurses, pharmacists, and primary/acute care/post-acute prescribers from 9 US states participated in individual qualitative interviews. MEASURES: Interview questions were focused on the experience, processes, roles, training, workflow, and challenges of deprescribing in hospital-to-home transitions. We used the constant comparison approach to identify and compare findings among patient, prescriber, and pharmacist and HHC nurse stakeholders. RESULTS: We interviewed 9 older patients, 11 HHC nurses, 5 primary care physicians (PCP), 3 pharmacists, 1 hospitalist, and 1 post-acute nurse practitioner. Four challenges were described in post-acute deprescribing for HHC patients. First, PCPs' time constraints, the timing of patient encounters after hospital discharge, and the lack of prioritization of deprescribing make it difficult for PCPs to initiate post-acute deprescribing. Second, patients are often confused about their medications, despite the care team's efforts in educating the patients. Third, communication is challenging between HHC nurses, PCPs, specialists, and hospitalists. Fourth, the roles of HHC nurses and pharmacists are limited in care team collaboration and discussion about post-acute deprescribing. CONCLUSIONS AND IMPLICATIONS: Post-acute deprescribing relies on multiple parties in the care team yet it has challenges. Interventions to align the timing of deprescribing and that of post-acute care visits, prioritize deprescribing and allow clinicians more time to complete related tasks, improve medication education for patients, and ensure effective communication in the care team with synchronized electronic health record systems are needed to advance deprescribing during the transition from hospital to home.


Assuntos
Desprescrições , Serviços de Assistência Domiciliar , Humanos , Idoso , Pesquisa Qualitativa , Transferência de Pacientes , Cuidados Semi-Intensivos
9.
Clin Biomech (Bristol, Avon) ; 111: 106138, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37948988

RESUMO

BACKGROUND: The purpose of this study was to determine the effect of a multicomponent rehabilitation protocol on functional outcomes in a post-acute care facility. METHODS: Eleven older, medically complex patients (80.3 ± 7.3 yrs) completed a multicomponent rehabilitation protocol during a stay at a post-acute care facility. Gait speed, Berg Balance scores, and sit-to-stand velocity were examined upon admission and discharge. Bayesian paired sample t-tests were used to determine changes from PRE to POST and linear regression analyses were used to determine the influence of length of stay. FINDINGS: Gait speed increased by 0.26 m/s (49% increase) from PRE (0.65 ± 0.38 m/s) to POST (0.90 ± 0.42 m/s) exercise intervention (p = 0.013). Berg Balance Scores significantly increased by 26% from PRE (38.27 ± 8.33) to POST (45.73 ± 3.32) exercise intervention (p = 0.009). A 45% increase in STS velocity from PRE (0.37 ± 0.14 m/s) to POST (0.51 ± 0.13 m/s; p ≤ 0.001) was observed following the multicomponent rehabilitation protocol. Length of stay did not influence improvements in gait speed, Berg Balance Scores, nor Sit-to-stand velocity (p = 0.176-0.811). INTERPRETATIONS: The multicomponent rehabilitation protocol with movement velocity biofeedback is feasible in a post-acute care facility in medically complex older patients and demonstrates improvements in clinical mobility and balance outcomes.


Assuntos
Exercício Físico , Cuidados Semi-Intensivos , Humanos , Teorema de Bayes , Velocidade de Caminhada , Terapia por Exercício/métodos , Equilíbrio Postural
10.
J Hosp Med ; 19(1): 40-44, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37867290

RESUMO

Skilled nursing facilities (SNF) represent a common postdischarge destination for hospitalized older adults. The goals of SNF care include the completion of extended skilled nursing care and physical rehabilitation to enable patients to safely return home. However, nearly one in four older adults discharged to SNF are rehospitalized and one in five seek care in the emergency department (ED) but are discharged back to SNF. Our aim was to measure the national prevalence and costs to Medicare of ED visits by SNF patients. Of the 1,551,703 Medicare beneficiaries discharged to SNF in 2019, 16.3% had an ED visit within 14 days (n = 253,104). Of those ED visits, 25.5% resulted in a same-day discharge back to SNF (n = 64,472), costing Medicare $24.6 million. Novel care models that can leverage SNF staff and resources while providing rapid diagnostic services are urgently needed.


Assuntos
Alta do Paciente , Readmissão do Paciente , Idoso , Humanos , Estados Unidos , Instituições de Cuidados Especializados de Enfermagem , Cuidados Semi-Intensivos , Assistência ao Convalescente , Medicare , Serviço Hospitalar de Emergência , Estudos Retrospectivos
11.
Am J Health Syst Pharm ; 81(Supplement_1): S8-S14, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-37979151

RESUMO

PURPOSE: To characterize the susceptibilities of positive bacterial cultures and the appropriateness of empiric antimicrobial regimens for patients admitted from post-acute care facilities (PACFs). METHODS: This was a retrospective quality improvement study. The study included patients admitted from a PACF to one of 2 tertiary care teaching hospitals within the University of Pennsylvania Health System, located in Philadelphia, PA, from August 2020 to December 2021. Patients were included if they had at least one positive culture within 72 hours of admission. RESULTS: A total of 167 patients and 230 isolates from the study period were evaluated. The majority of positive cultures were from a urinary source (114 of 230, 49.6%). Nineteen patients (11.4%) had a history of multidrug-resistant organisms. The most common empiric antibiotics used were vancomycin (61.7%) and cefepime (59.3%). Sixty-one patients (36.5%) received inappropriate empiric therapy based on the culture results. When comparing our hospitals' general antibiogram to that of only PACF patients, Escherichia coli and Klebsiella pneumoniae had at least a 20% difference in susceptibility to levofloxacin, ceftriaxone, and cefepime. Extended-spectrum ß-lactamase resistance was also higher in the PACF cohort (odds ratio, 2.09; 95% confidence interval, 1.4-3.1). CONCLUSION: Clinically significant differences in antimicrobial susceptibility were found among patients admitted from PACFs compared to our health system's general antibiogram. The increased resistance rates identified in this study support the need for hospitals to evaluate this at-risk patient population, which may drive changes to empiric antibiotic prescribing practices.


Assuntos
Antibacterianos , Anti-Infecciosos , Humanos , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Estudos Retrospectivos , Cefepima , Cuidados Semi-Intensivos , Farmacorresistência Bacteriana , Testes de Sensibilidade Microbiana , Escherichia coli
12.
J Am Med Dir Assoc ; 25(1): 61-68, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37935380

RESUMO

OBJECTIVES: To evaluate the evolution and challenges of China's post-acute care (PAC) system over the past 20 years and suggest actionable policy recommendations for its improvement. DESIGN: A retrospective review of policies and initiatives aimed at PAC system development, analyzed alongside unsolved challenges in light of global PAC practices, informed by literature reviews and collaborative discussion. SETTING AND PARTICIPANTS: PAC in China involves diverse settings such as general hospitals, inpatient rehabilitation centers, skilled nursing facilities, community health centers, and homes. The patients are mainly those discharged from acute hospitals with functional impairment and in need of continuous care. METHOD: An extensive search of government policy documents, statistical sources, peer-reviewed studies, and the gray literature. The research team conducted literature reviews and discussions regularly to shape the findings. RESULTS: China has strengthened its PAC system through improved rehabilitation and nursing infrastructure, establishment of tiered rehabilitation networks, and adoption of innovative payment methods. However, challenges persist, including a lack of clinical consensus, resource constraints in PAC facilities and among professionals, the need for integrated care coordination, and the unification of PAC assessment tools and payment mechanisms. CONCLUSIONS AND IMPLICATIONS: Although China has made substantial progress in its PAC system over 2 decades, continued efforts are needed to address its lingering challenges. Elevating awareness of PAC's significance and instituting policy adjustments targeting these challenges are essential for the system's optimization.


Assuntos
Centros de Reabilitação , Cuidados Semi-Intensivos , Humanos , Estudos Retrospectivos , Alta do Paciente , China
13.
Child Care Health Dev ; 50(1): e13179, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37747458

RESUMO

BACKGROUND: Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. METHODS: As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. RESULTS: Patients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66-1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95-210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day. CONCLUSIONS: Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.


Assuntos
Hospitalização , Cuidados Semi-Intensivos , Criança , Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança Hospitalizada , Meio Ambiente , Hospitais Pediátricos
14.
J Am Med Dir Assoc ; 25(1): 69-83, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37838000

RESUMO

OBJECTIVES: To determine the scope of the application of natural language processing to free-text clinical notes in post-acute care and provide a foundation for future natural language processing-based research in these settings. DESIGN: Scoping review; reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. SETTING AND PARTICIPANTS: Post-acute care (ie, home health care, long-term care, skilled nursing facilities, and inpatient rehabilitation facilities). METHODS: PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched in February 2023. Eligible studies had quantitative designs that used natural language processing applied to clinical documentation in post-acute care settings. The quality of each study was appraised. RESULTS: Twenty-one studies were included. Almost all studies were conducted in home health care settings. Most studies extracted data from electronic health records to examine the risk for negative outcomes, including acute care utilization, medication errors, and suicide mortality. About half of the studies did not report age, sex, race, or ethnicity data or use standardized terminologies. Only 8 studies included variables from socio-behavioral domains. Most studies fulfilled all quality appraisal indicators. CONCLUSIONS AND IMPLICATIONS: The application of natural language processing is nascent in post-acute care settings. Future research should apply natural language processing using standardized terminologies to leverage free-text clinical notes in post-acute care to promote timely, comprehensive, and equitable care. Natural language processing could be integrated with predictive models to help identify patients who are at risk of negative outcomes. Future research should incorporate socio-behavioral determinants and diverse samples to improve health equity in informatics tools.


Assuntos
Processamento de Linguagem Natural , Cuidados Semi-Intensivos , Humanos , Documentação
15.
Drug Ther Bull ; 61(12): 181, 2023 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-37898506

RESUMO

Overview of: Vasilevskis EE, Shah AS, Hollingsworth EK, et al. deprescribing medications among older adults from end of hospitalization through postacute care: a Shed-MEDS randomized clinical trial. JAMA Intern Med 2023;183:223-31.


Assuntos
Desprescrições , Humanos , Idoso , Cuidados Semi-Intensivos , Hospitais , Hospitalização , Polimedicação
16.
Artigo em Inglês | MEDLINE | ID: mdl-37887697

RESUMO

In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.


Assuntos
COVID-19 , Cuidadores , Humanos , Idoso , Estados Unidos , COVID-19/epidemiologia , Cuidados Semi-Intensivos , Pandemias , Medicare , Políticas
17.
Aging Clin Exp Res ; 35(11): 2847-2849, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37823996

RESUMO

Literature review reveals that adherence to prescribed therapy at hospital discharge averages around 50%. The purpose of this study was to evaluate adherence to prescribed therapy assessing the relationship between re-hospitalization rate at 30 days and degree of therapeutic adherence in a sample of elderly patients discharged from an acute geriatric ward using an Electronic Medication Packaging device, MePill. The study population (n = 56) was divided in 3 groups, a counseling group (A), a counseling + MePill device group (B) and a control group (C). Group A had 98.1% adherence to therapy, Group B had 100%, and control group had 90%. Analyzing the rate of hospitalization by type of intervention for Group A and C the hospitalization rate was 21% and 27.7%, respectively, whilst for Group B no patient was hospitalized. Participants in Group A and C had the shorter hospitalization-free survival as compared with subjects in Group B.


Assuntos
Hospitalização , Cuidados Semi-Intensivos , Humanos , Idoso , Projetos Piloto , Cooperação e Adesão ao Tratamento , Eletrônica , Adesão à Medicação
18.
J Health Econ ; 92: 102823, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37839286

RESUMO

Nursing homes serve both long-term care and post-acute care (PAC) patients, two groups with distinct financing mechanisms and requirements for care. We examine empirically the effect of nursing home specialization in PAC using 2011-2018 data for Medicare patients admitted to nursing homes following a hospital stay. To address patient selection into specialized nursing homes, we use an instrumental variables approach that exploits variation over time in the distance from the patient's residential ZIP code to the closest nursing home with different levels of PAC specialization. We find that patients admitted to nursing homes more specialized in PAC have lower hospital readmissions and mortality, longer nursing home stays, and higher Medicare spending for the episode of care, suggesting that specialization improves patient outcomes but at higher costs.


Assuntos
Alta do Paciente , Cuidados Semi-Intensivos , Idoso , Humanos , Estados Unidos , Medicare , Casas de Saúde , Instituições de Cuidados Especializados de Enfermagem
19.
BMC Neurol ; 23(1): 343, 2023 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-37770846

RESUMO

BACKGROUND: The postacute care for cerebrovascular disease (PAC-CVD) program was launched in Taiwan nearly a decade ago. However, no clear regulations regarding length of stay (LOS) in the program and extension standards exist. Thus, the allocation of limited medical resources such as hospital beds is a major issue. METHODS: This novel study retrospectively investigated the effects of functional performance and national health insurance (NHI) costs on PAC-CVD LOS. Data for 263 patients with stroke who participated in the PAC-CVD program were analysed. Hierarchical multiple regression was used to estimate the effects of functional performance and NHI costs on LOS at three time points: weeks 3, 6, and 9. RESULTS: At week 3, age, NHI costs, modified Rankin scale score, and Barthel index significantly affected LOS, whereas at week 6, age and NHI costs were significant factors. However, functional performance and NHI costs were not significant factors at week 9. CONCLUSIONS: The study provides crucial insights into the factors affecting LOS in the PAC-CVD program, and the results can enable medical decision-makers and health care teams to develop inpatient rehabilitation plans or provide transfer arrangements tailored to patients. Specifically, this study highlights the importance of early functional recovery and consideration of NHI costs when managing LOS in the PAC-CVD program.


Assuntos
Acidente Vascular Cerebral , Cuidados Semi-Intensivos , Humanos , Estudos Retrospectivos , Hospitalização , Acidente Vascular Cerebral/terapia , Tempo de Internação , Programas Nacionais de Saúde , Desempenho Físico Funcional
20.
JAMA Health Forum ; 4(8): e232517, 2023 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-37594745

RESUMO

Importance: Better evidence is needed on whether Medicare Advantage (MA) plans can control the use of postacute care services while achieving excellent outcomes. Objective: To compare self-reported use of postacute care services and outcomes among traditional Medicare (TM) beneficiaries and MA enrollees. Design, Setting, and Participants: This cohort study used data from the National Health and Aging Trends Study (NHATS) with linked Medicare enrollment data from 2015 to 2017. Participants were community-dwelling MA or TM beneficiaries 70 years and older; those with dual Medicare and Medicaid eligibility were also identified. Analyses were conducted from May 2022 to February 2023 and were weighted to account for the complex survey design. Exposures: Enrollment in MA and dual eligibility for Medicare and Medicaid. Main Outcomes and Measures: Postacute care service use including site of use, duration, primary indication, and whether participants met their goals or experienced improved functional status during or after services. Results: Included in the analysis were 2357 Medicare beneficiaries who used postacute care. Of these beneficiaries, 815 (32.6%; 62.0% were females [weighted percentages]) had MA and 1542 (67.4%; 59.5% were females [weighted percentages]) had TM. Enrollees in MA reported using postacute care services across all NHATS survey rounds: between 16.2% (95% CI, 14.3%-18.4%) and 17.7% (95% CI, 15.4%-20.4%) of MA enrollees reported using postacute care services each round, vs 22.4% (95% CI, 20.9%-24.1%) to 24.1% (95% CI, 21.8%-26.6%) of TM beneficiaries (P for all rounds <.002). Enrollees in MA reported less functional improvement during postacute care use (63.1% [95% CI, 59.2%-66.8%] vs 71.7% [95% CI, 68.9%-74.3%], P < .001). Among beneficiaries who ended postacute service use, fewer MA enrollees than TM enrollees reported that they met their goals (70.5% [95% CI, 65.1%-75.3%] vs 76.2% [95% CI, 73.1%-79.1%]; P = .053) or had improved functional status (43.9% [95% CI, 38.9%-49.1%] vs 46.0% [95% CI, 42.5%-49.5%]; P = .42), but differences were not statistically significant. Differences in postacute care use and functional improvement were not statistically significant between MA and TM enrollees with dual eligibility. Conclusions and relevance: In this cohort study of Medicare beneficiaries, we found that MA enrollees overall used less postacute care services than their TM counterparts. Among users of postacute care services, MA enrollees reported less favorable outcomes compared with TM enrollees. These findings highlight the importance of assessing patient-reported outcomes, especially as MA and other payment models seek to reduce inefficient use of postacute care services.


Assuntos
Medicare Part C , Estados Unidos , Feminino , Idoso , Humanos , Masculino , Estudos de Coortes , Cuidados Semi-Intensivos , Medicaid , Envelhecimento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...