Do Medicare Inpatient Rehabilitation Facility Patients' Self-Care and Mobility Outcomes Vary by Dual Eligibility Status, Race and Ethnicity, Rural Residence, Socioeconomic Status, and Living Alone?

OBJECTIVE: To examine whether inpatient rehabilitation facility (IRF) patients' risk-adjusted functional outcomes varied with five social drivers of health: Medicare-Medicaid dual eligibility status, race and ethnicity, rural residence, socioeconomic status (SES), and living alone. DESIGN: This cohort study examined unadjusted and adjusted mobility and self-care change scores during IRF stays for 428,710 Medicare patients with and without social drivers of health. Regression models isolated the mean marginal effect of each of the five social factors on mobility and self-care change scores after adjusting for covariates. RESULTS: Patients with full dual status had slightly lower risk-adjusted mobility and self-care improvement (-4.5% and -3.3%, respectively) compared to patients without dual status. Patients who identified as Black, Asian and Native Hawaiian had self-care marginal effects that were slightly lower (-4.8%, -4.1% and -3.7%, respectively) than patients who were White. Patients living in lower SES neighborhoods and patients who lived alone had slightly higher mobility and self-care improvement scores. Risk-adjusted marginal differences in improvement scores for patients with and without these social factors were small and did not meet the meaningfully different criteria. CONCLUSIONS: Overall, IRF patients' risk-adjusted functional outcomes did not vary meaningfully by dual eligibility status, race or ethnicity, rural residence, SES or living alone.

Genetic synergy between Acinetobacter baumannii undecaprenyl phosphate biosynthesis and the Mla system impacts cell envelope and antimicrobial resistance.

Acinetobacter baumannii is a Gram-negative bacterial pathogen that poses a major health concern due to increasing multidrug resistance. The Gram-negative cell envelope is a key barrier to antimicrobial entry and includes an inner and outer membrane. The maintenance of lipid asymmetry (Mla) system is the main homeostatic mechanism by which Gram-negative bacteria maintain outer membrane asymmetry. Loss of the Mla system in A. baumannii results in attenuated virulence and increased susceptibility to membrane stressors and some antibiotics. We recently reported two strain variants of the A. baumannii type strain ATCC 17978: 17978VU and 17978UN. Here, ∆mlaF mutants in the two ATCC 17978 strains display different phenotypes for membrane stress resistance, antibiotic resistance, and pathogenicity in a murine pneumonia model. Although allele differences in obgE were previously reported to synergize with ∆mlaF to affect growth and stringent response, obgE alleles do not affect membrane stress resistance. Instead, a single-nucleotide polymorphism (SNP) in the essential gene encoding undecaprenyl pyrophosphate (Und-PP) synthase, uppS, results in decreased enzymatic rate and decrease in total Und-P levels in 17978UN compared to 17978VU. The UppSUN variant synergizes with ∆mlaF to reduce capsule and lipooligosaccharide (LOS) levels, increase susceptibility to membrane stress and antibiotics, and reduce persistence in a mouse lung infection. Und-P is a lipid glycan carrier required for the biosynthesis of A. baumannii capsule, cell wall, and glycoproteins. These findings uncover synergy between Und-P and the Mla system in maintaining the A. baumannii cell envelope and antibiotic resistance.IMPORTANCEAcinetobacter baumannii is a critical threat to global public health due to its multidrug resistance and persistence in hospital settings. Therefore, novel therapeutic approaches are urgently needed. We report that a defective undecaprenyl pyrophosphate synthase (UppS) paired with a perturbed Mla system leads to synthetically sick cells that are more susceptible to clinically relevant antibiotics and show reduced virulence in a lung infection model. These results suggest that targeting UppS or undecaprenyl species and the Mla system may resensitize A. baumannii to antibiotics in combination therapies. This work uncovers a previously unknown synergistic relationship in cellular envelope homeostasis that could be leveraged for use in combination therapy against A. baumannii.

What Drove Program Participants to Initially Attend Congregate Meals? Socialization, Health, and Other Reasons.

The Congregate Nutrition Services support efforts to keep older Americans independent and engaged in their communities. We examined participants' self-reported reasons for initially attending the congregate meals program and whether reasons differed by participant characteristics. Descriptive statistics and tests of differences were used to compare participants (n = 1,072). Individuals attended congregate meals for several reasons, with the top two being socialization (36.3%) and age- or health-related reasons (18.7%). Those attending for socialization were less likely to be lower income, have food insecurity, or live with 3+ ADL limitations while participants who first attended due to age or health-related reasons were more likely to be low income, food insecure, and from historically marginalized populations. Health and social service professionals and community organizations could expand data collection on older adults in their communities and partner with congregate meal providers to encourage participation for individuals with unmet nutritional, health, and socialization needs.

Genetic synergy in Acinetobacter baumannii undecaprenyl biosynthesis and maintenance of lipid asymmetry impacts outer membrane and antimicrobial resistance.

Acinetobacter baumannii is a Gram-negative healthcare-associated pathogen that poses a major health concern due to increasing multidrug resistance. The Gram-negative cell envelope is a key barrier to antimicrobial entry and includes an inner and outer membrane. The outer membrane has an asymmetric composition that is important for structural integrity and barrier to the environment. Therefore, Gram-negative bacteria have mechanisms to uphold this asymmetry such as the maintenance of lipid asymmetry system (Mla), which removes glycerophospholipids from the outer leaflet of the outer membrane and transports them to the inner membrane. Loss of this system in A. baumannii results in attenuated virulence and increased susceptibility to membrane stressors and some antibiotics. We recently reported two strain variants of the A. baumannii type strain ATCC 17978, 17978VU and 17978UN. We show here that ΔmlaF mutants in the two strains display different phenotypes for membrane stress resistance, antibiotic resistance, and pathogenicity in a murine pneumonia model. We used comparative genetics to identify interactions between ATCC 17978 strain alleles and mlaF to uncover the cause behind the phenotypic differences. Although allele differences in obgE were previously reported to synergize with ΔmlaF to affect growth and stringent response, we show that obgE alleles do not affect membrane stress resistance. Instead, a single nucleotide polymorphism (SNP) in the essential gene encoding undecaprenyl pyrophosphate (Und-PP) synthase, uppS, synergizes with ΔmlaF to increase susceptibility to membrane stress and antibiotics, and reduce persistence in a mouse lung infection. Und-P is a lipid glycan carrier known to be required for biosynthesis of A. baumannii capsule, cell wall, and glycoproteins. Our data suggest that in the absence of the Mla system, the cellular level of Und-P is critical for envelope integrity, antibiotic resistance, and lipooligosaccharide abundance. These findings uncover synergy between Und-P and the Mla system in maintaining the A. baumannii outer membrane and stress resistance.

Characteristics and Outcomes of Medicare Patients Treated in Inpatient Rehabilitation Facilities: 2013-2018.

PURPOSE: The aim of this study was to describe the characteristics and outcomes of Medicare patients treated in inpatient rehabilitation facilities (IRFs) in 2013 through 2018. DESIGN: A descriptive study was conducted. METHODS: A total of 2,907,046 IRF Medicare fee-for-service and Medicare Advantage patient stays that ended in 2013 through 2018 were analyzed. RESULTS: The number of Medicare patients treated in IRFs increased by about 9%, from 466,092 in 2013 to 509,475 in 2018. Although IRF patients' age and racial/ethnic composition remained similar across the years, there was a shift in patients' primary rehabilitation diagnosis, with more patients with stroke, neurological conditions, traumatic and nontraumatic brain injury, fewer patients with orthopedic conditions, and fewer coded as having medically complex conditions. Across the years, the percentage of patients discharged to the community was between 73.0% and 74.4%. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses should have training and expertise in the management of patients with stroke and neurological conditions to provide high-quality IRF care. CONCLUSIONS: Between 2013 and 2018, the number of Medicare patients treated in IRFs increased overall. There were more patients with stroke and neurological conditions and fewer patients with orthopedic conditions. Changes to IRF and other post-acute care policies, Medicaid expansion, and alternative payment programs may partially be driving these changes.

Acinetobacter Metabolism in Infection and Antimicrobial Resistance.

Acinetobacter infections have high rates of mortality due to an increasing incidence of infections by multidrug-resistant (MDR) and extensively-drug-resistant (XDR) strains. Therefore, new therapeutic strategies for the treatment of Acinetobacter infections are urgently needed. Acinetobacter spp. are Gram-negative coccobacilli that are obligate aerobes and can utilize a wide variety of carbon sources. Acinetobacter baumannii is the main cause of Acinetobacter infections, and recent work has identified multiple strategies A. baumannii uses to acquire nutrients and replicate in the face of host nutrient restriction. Some host nutrient sources also serve antimicrobial and immunomodulatory functions. Hence, understanding Acinetobacter metabolism during infection may provide new insights into novel infection control measures. In this review, we focus on the role of metabolism during infection and in resistance to antibiotics and other antimicrobial agents and discuss the possibility that metabolism may be exploited to identify novel targets to treat Acinetobacter infections.

Reliability and Validity of the Inpatient Rehabilitation Facility Discharge Mobility and Self-Care Quality Measures.

OBJECTIVE: To describe the reliability and validity of the publicly reported facility-level quality measures Inpatient Rehabilitation Facility (IRF) Discharge Mobility Score for Medical Rehabilitation Patients ("Discharge mobility score") and IRF Discharge Self-Care Score for Medical Rehabilitation Patients ("Discharge self-care score"). DESIGN: Observational study using standardized patient assessment data to examine facility-level split-half reliability and construct validity of quality measure scores. SETTING AND PARTICIPANTS: All IRFs (n = 1117) in the United States with at least 20 Medicare stays. Facility-level quality measure scores were calculated from 2017 data on 428,192 Medicare (fee-for-service and Medicare Advantage) IRF patient stays. METHODS: Using clinician-reported assessment data, we calculated facility-level mobility and self-care quality measure scores and examined reliability of these scores using split-half analysis and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC2,1). We examined construct validity of these scores by comparing facility-level quality measure scores by facility stroke disease-specific certification status. RESULTS: Reported as percentages meeting or exceeding expectations, IRF quality measure scores ranged from 8.3% to 90.1% for mobility and 9.0% to 90.3% for self-care. IRF scores, when split in half to examine reliability, showed strong, positive correlations for the mobility (Pearson = 0.898, Spearman = 0.898, ICC = 0.898) and self-care (Pearson = 0.886, Spearman = 0.874, ICC = 0.886) scores. When stratified by provider volume, ICCs remained strong. Construct validity analyses showed IRFs with stroke disease-specific certification had higher mean and median scores than IRFs without certification, and a greater proportion of IRFs that were certified had higher scores. CONCLUSION AND IMPLICATIONS: Our results support the reliability and construct validity of the IRF quality measures Discharge mobility and Discharge self-care scores. Reported as percentages meeting or exceeding expectations, these quality measures are designed to be more consumer-friendly compared to change scores.

Dementia's Unique Burden: Function and Health Care in the Last 4 Years of Life.

BACKGROUND: Dementia is a terminal illness marked by progressive cognitive decline. This study characterized trajectories of functional status and health care use for people with and without dementia at the end of their life. METHODS: We used the Health and Retirement Study linked with Medicare claims to generate a series of generalized linear models. Models predicted functional status and health care use for decedents with and without dementia during each month in the last 4 years of life (48 months). RESULTS: People with dementia have high, sustained functional impairments during the entire last 4 years of life. People with dementia have the same predicted average activities of daily living score (1.92) at 17 months before death (95% confidence interval [CI]: 1.857, 1.989) as individuals without dementia at 6 months before death (95% CI: 1.842, 1.991). Dementia was associated with significantly less hospice during the final 3 months of life, with a 12.5% (95% CI: 11.046, 13.906) likelihood of hospice in the last month of life with dementia versus 17.3% (95% CI: 15.573, 18.982) without dementia. Dementia was also associated with less durable medical equipment (p < .001), less home health care (p < .005), and fewer office visits (p < .001). There were not significant differences in likelihood of hospitalization in the last 48 months with or without dementia. CONCLUSIONS: People with dementia can functionally appear to be at end of life (EOL) for years before their death. Simultaneously, they receive less health care, particularly home health and hospice, in their last months. Models of care that target people with dementia should consider the unique and sustained burden of dementia at EOL.

Validation of the Standardized Function Data Elements among Medicare Skilled Nursing Facility Residents.

OBJECTIVE: To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge. DESIGN: Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge. SETTING AND PARTICIPANTS: Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs. METHODS: We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity. RESULTS: Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements. CONCLUSIONS AND IMPLICATIONS: Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents.

Self-Other Balance in Context: A Quiet Ego May Be Meaningful and Adaptive in Latinx/Hispanic Cultures and Work Settings.

Quiet ego is a relatively novel, increasingly studied, multi-dimensional concept characterized by a compassionate, interdependent worldview and an adaptive balance between self-interest and concern for others. Quiet ego has been associated with a range of characteristics that can promote relationship quality, responding effectively in the face of challenges, and greater well-being. However, it is currently unknown to what extent quiet ego translates across cultures and settings. The present research leverages cultural and organizational theories to evaluate the conceptual and structural validity of quiet ego for Latinx/Hispanic individuals in the U.S. and to examine relationships among quiet ego, work supervisor relationship quality, and goals in the workplace. Employed college student participants (n = 831; nLatinx/Hispanic = 305) completed an online survey, and collected data were subjected to confirmatory factor analysis and path analysis. Findings confirmed the overall structural model of quiet ego with four primary dimensions (perspective taking, inclusive identity, detached awareness, and growth-mindedness) and indicated that this structure did not differ between Latinx/Hispanic and non-Latinx/Hispanic subsamples. Further, results cohered with the proposed model suggesting that quiet ego might facilitate relationship quality with a workplace supervisor, which, in turn could foster balanced, intrinsically motivating perceptions that one's work goals benefit both oneself and others (mutual gain motivation). The study suggests that quiet ego may be a construct with meaning and utility in Latinx/Hispanic populations and in employment settings. However, further research is needed, and specific suggestions for future study are discussed.

Mobile genetic elements in Acinetobacter antibiotic-resistance acquisition and dissemination.

Pathogenic Acinetobacter species, most notably Acinetobacter baumannii, are a significant cause of healthcare-associated infections worldwide. Acinetobacter infections are of particular concern to global health due to the high rates of multidrug resistance and extensive drug resistance. Widespread genome sequencing and analysis has determined that bacterial antibiotic resistance is often acquired and disseminated through the movement of mobile genetic elements, including insertion sequences (IS), transposons, integrons, and conjugative plasmids. In Acinetobacter specifically, resistance to carbapenems and cephalosporins is highly correlated with IS, as many ISAba elements encode strong outwardly facing promoters that are required for sufficient expression of ß-lactamases to confer clinical resistance. Here, we review the role of mobile genetic elements in antibiotic resistance in Acinetobacter species through the framework of the mechanism of resistance acquisition and with a focus on experimentally validated mechanisms.

Gram-negative bacteria act as a reservoir for aminoglycoside antibiotics that interact with host factors to enhance bacterial killing in a mouse model of pneumonia.

In vitro exposure of multiple Gram-negative bacteria to an aminoglycoside (AG) antibiotic has previously been demonstrated to result in bacterial alterations that interact with host factors to suppress Gram-negative pneumonia. However, the mechanisms resulting in suppression are not known. Here, the hypothesis that Gram-negative bacteria bind and retain AGs, which are introduced into the lung and interact with host defenses to affect bacterial killing, was tested. Following in vitro exposure of one of several, pathogenic Gram-negative bacteria to the AG antibiotics kanamycin or gentamicin, AGs were detected in bacterial cell pellets (up to 208 µg/mL). Using inhibitors of AG binding and internalization, the bacterial outer membrane was implicated as the predominant kanamycin and gentamicin reservoir. Following intranasal administration of gentamicin-bound bacteria or gentamicin solution at the time of infection with live, AG-naïve bacteria, gentamicin was detected in the lungs of infected mice (up to 8 µg/g). Co-inoculation with gentamicin-bound bacteria resulted in killing of AG-naïve bacteria by up to 3-log10, mirroring the effects of intranasal gentamicin treatment. In vitro killing of AG-naïve bacteria mediated by kanamycin-bound bacteria required the presence of detergents or pulmonary surfactant, suggesting that increased bacterial killing inside the murine lung is facilitated by the detergent component of pulmonary surfactant. These findings demonstrate that Gram-negative bacteria bind and retain AGs that can interact with host-derived pulmonary surfactant to enhance bacterial killing in the lung. This may help explain why AGs appear to have unique efficacy in the lung and might expand their clinical utility.

Change in Mobility Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and the Risk Adjustment Model.

OBJECTIVE: To describe the exclusion criteria and updated risk adjustment model developed for the Change in Mobility quality measure in the inpatient rehabilitation facility (IRF) quality reporting program. Facility-level quality measures focused on patient outcomes usually require risk adjustment to account for varied admission characteristics of patients across facilities. DESIGN: This cohort study analyzed admission demographic and clinical factors associated with mobility change scores using the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data for Medicare patients discharged from IRFs in calendar year 2017. SETTING: A total of 1129 IRFs in the United States. PARTICIPANTS: A total of 493,209 (N=493, 209) Medicare fee-for-service and Medicare Advantage IRF patient stays discharged in calendar year 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility change scores using admission and discharge standardized assessment data from the IRF-PAI. RESULTS: Approximately 53% of patients in the study were female, 67% were aged 65-84 years, and nearly 80% were White. In the final risk adjustment model, 105 covariates were included, explaining 20% of variance in mobility change scores. Key risk adjusters included IRF primary diagnosis group, prior indoor ambulation functioning, age older than 90 years, and 14 of the comorbidities. The model showed good calibration across the range of deciles of predicted IRF mobility change scores; the ratio of the average expected to observed change scores ranged from 0.93-1.03, with all but 1 within ±0.03. CONCLUSIONS: The updated risk adjustment model uses IRF patients' demographic and clinical characteristics to predict their mobility change scores. The exclusion criteria and resulting risk model are used to calculate the risk adjusted Change in Mobility quality measure scores, enabling comparisons of Change in Mobility scores across IRFs.

Change in Self-Care Quality Measure for Inpatient Rehabilitation Facilities: Exclusion Criteria and Risk-Adjustment Model.

OBJECTIVE: To describe the exclusion criteria and risk-adjustment model developed for the quality measure Change in Self-Care. The exclusion criteria and risk adjustment model are used to calculate Change in Self-Care scores, allowing scores to be compared across inpatient rehabilitation facilities (IRFs). DESIGN: This national cohort study examined admission demographic and clinical factors associated with IRF patients' self-care change scores using standardized self-care data for Medicare patients discharged in calendar year 2017. SETTING: A total of 1129 IRFs in the United States. PARTICIPANTS: A total of 493,209 (N=493,209) Medicare Fee-for-Service and Medicare Advantage IRF patient stays INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-care change scores using admission and discharge standardized assessment data elements from the Inpatient Rehabilitation Facility-Patient Assessment Instrument. RESULTS: Approximately 53% of patients were female, and 67% were between 65 and 84 years old. The final risk-adjustment model contained 93 clinically relevant risk adjusters and explained 23.1% of variance in self-care change scores. Risk adjusters that had the greatest effect on change scores and included IRF primary diagnosis group (ie, binary risk adjusters representing 13 diagnoses), prior self-care functioning, and age older than 90 years. When split by deciles of expected scores, the ratio of the average expected and observed change scores was within 2% of 1.0 across 8 groups and within 8% at the extremes, showing good predictive accuracy. CONCLUSIONS: The risk adjustment model quantifies the relationship between IRF patients' demographic and clinical characteristics and their self-care score changes. The exclusion criteria and model are used to risk-adjust the IRF Change in Self-Care quality measure.

Inpatient Rehabilitation Facility Change in Self-Care and Change in Mobility Quality Measures: Development and Reliability and Validity Testing.

OBJECTIVE: To describe the development, implementation and reliability and validity testing of the inpatient rehabilitation facility (IRF) Change in Self-Care and Change in Mobility quality measures. DESIGN: We describe the activities involved in developing and implementing the 2 facility-level quality measures, including public comment opportunities. We examined facility-level reliability using split-half testing and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC2,1). We examined validity by comparing facility-level quality measure scores and facility disease-specific certification status. SETTING: All 1117 IRFs in the United States with at least 20 Medicare stays that ended in 2017. PARTICIPANTS: Facility-level quality measure scores (N=1117) were derived from data from 427,517 (self-care) and 427,956 (mobility) Medicare fee-for-service and Medicare Advantage IRF patient stays in 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Facility-level Change in Self-Care and Change in Mobility quality measure scores and facility Disease-Specific Certification for Stroke Rehabilitation from The Joint Commission were used in validity analysis. RESULTS: The split-half quality measure scores showed strong, positive correlations for the facility-level self-care (Pearson=0.903, Spearman=0.884, ICC=0.903, P<.0001) and mobility (Pearson=0.903, Spearman=0.884, ICC= 0.903, P<.0001) quality measure scores, providing evidence of reliability. ICCs remained strong when stratifying by provider volume. IRFs with stroke certification had slightly higher mean and median quality measure scores than IRFs without certification, and IRFs with the higher quality measure scores tended to have a higher percentage of certified IRFs. CONCLUSIONS: Our analyses support the reliability and validity of the Change in Self-Care and Change in Mobility quality measure scores in IRFs.

A Postacute Care Function Process Quality Measure for the Collection of Standardized Self-Care and Mobility Data: Development, Implementation, and Quality Measure Scores.

OBJECTIVE: To describe the development of and quality measure scores for the cross-setting postacute care function process quality measure that requires the collection of standardized self-care and mobility data at admission and discharge and at least 1 function goal. DESIGN: Description of the development and implementation of the quality measure and the associated standardized self-care and mobility data elements. Descriptive analyses of quality measure scores for the first calendar year using data from the Minimum Data Set, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Long-Term Care Hospitals (LTCH) Continuity Assessment Record and Evaluation Data Set, and Outcome and Assessment Information Set. SETTING: 15,127 skilled nursing facilities (SNFs), 1129 inpatient rehabilitation facilities (IRFs), 414 LTCHs, and 10,352 home health agencies (HHAs) in the United States. PARTICIPANTS: In total there were 9,216,943 stays/quality episodes (N = 9,216,943), including 2,084,774 SNF Medicare fee-for-service patient stays, 493,209 IRF Medicare patient stays, 161,714 patient stays, and 6,477,246 Medicare and Medicaid quality episodes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Scores for the cross-setting postacute care function process quality measure. RESULTS: The mean process quality measure scores for SNFs, IRFs, LTCHs, and HHAs were 95.5%, 99.7%, 99.1%, and 95.8, respectively. The 10th percentile scores for SNFs, IRFs, LTCHs, and HHAs were 88.5%, 99.3%, 98.4%, and 89.4, respectively, indicating that at least 90% of postacute care providers submitted the standardized data for a large proportion of their patients. Mean quality measure scores did not vary by provider characteristics. CONCLUSIONS: Most SNFs, IRFs, LTCHs, and HHAs submitted the self-care and mobility data, resulting in high quality measure scores during the first year of implementation. The availability of the standardized self-care and mobility data across postacute care settings offers the opportunity to compare the characteristics and functional outcomes of patients treated in postacute care.

Inpatient Rehabilitation Facility Patients' Functional Abilities and Validity Testing of the Standardized Self-Care and Mobility Data Elements.

OBJECTIVE: To describe the abilities of Medicare patients in inpatient rehabilitation facilities (IRFs) at admission and discharge using the standardized self-care and mobility data elements and examine the validity of the data elements. These data are used in the Center for Medicare & Medicaid's IRF payment and quality reporting programs. DESIGN: Descriptive study reporting IRF patients' self-care and mobility scores. We also examined content validity and the associations between admission scores and length of stay (LOS), discharge scores and discharge destination, and change scores and the number of comorbidities. SETTING: Patients discharged from 1129 IRFs in 2017. PARTICIPANTS: IRF Medicare fee-for-service and Medicare Advantage patient stays (N = 493,209). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Self-care and mobility item scores, IRF LOS, discharge destination, and categories of the number of comorbidities. RESULTS: For each self-care and mobility activity, patients in IRFs overall made substantial improvements in function between admission and discharge. For example, the percentage of patients independent with eating and toilet transfers increased from 29.04% to 66.68% and 0.80% to 39.87%, respectively, between admission and discharge. Activities represented in the standardized data elements are included in other functional assessment instruments addressing content validity. Analyses showed a monotonic relationship between admission scores and LOS and between discharge scores and discharge to community percentages with only a few exceptions. Self-care and mobility scale change scores decreased as the number of comorbidities increased across categories. CONCLUSIONS: Patients in IRFs overall show functional improvement across each of the activities as defined by the standardized self-care and mobility data elements. The results showing the associations between patient functioning and 3 metrics (LOS, discharge to community rates, and number of comorbidities) support the validity of the data elements measuring functional abilities in the IRF Medicare population.

Comfort Expressing Emotions and Suicide Ideation: Evidence of Indirect Effects Via Perceived Burdensomeness and Thwarted Belongingness.

OBJECTIVE: Emotion regulation strategies and related constructs have been implicated both as risk and protective factors in a range of mental health outcomes among young adults. To expand upon this previous research, we examined comfort expressing four discrete emotions (i.e., love, happiness, sadness, and anger) as factors that protect against suicide ideation in young adults, within the context of the interpersonal theory of suicide. METHOD: The sample consisted of 449 college students (73.1% female, 70.6% Hispanic, Mage = 20.5 years) taking part in a larger study of mood and well-being. Students were recruited from a psychology participant pool and completed self-report measures at a single time point for course credit. Comfort expressing emotions and suicide ideation were assessed using the Measure of Verbally Expressed Emotion (MoVEE) and Adult Suicidal Ideation Questionnaire (ASIQ), respectively. Perceived burdensomeness and thwarted belongingness were assessed using the Interpersonal Needs Questionnaire (INQ). RESULTS: Preliminary analyses revealed negative associations between comfort expressing all four emotions and suicide ideation (rs = -.13 to -.26). Results from structural equation modeling supported indirect effects from comfort expressing happiness and sadness to suicide ideation, via perceived burdensomeness and thwarted belongingness. An indirect effect was also identified from comfort expressing love to suicide ideation, via thwarted belongingness. CONCLUSIONS: Results suggest that comfort expressing emotions (particularly sadness and happiness) is a protective factor against suicide ideation for young adults. These findings suggest that suicide-prevention efforts may wish to focus on increasing comfort expressing emotions to trusted support networks as potential intervention targets.HIGHLIGHTSComfort expressing emotions is negatively associated with suicide ideation.Comfort expressing emotions is associated with belongingness and burdensomeness.Comfort expressing emotions may be a potential target for suicide prevention.

Trends in the Use of Residential Settings Among Older Adults.

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time. METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002). RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05). DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

Identification of Two Variants of Acinetobacter baumannii Strain ATCC 17978 with Distinct Genotypes and Phenotypes.

Acinetobacter baumannii is a nosocomial pathogen that exhibits substantial genomic plasticity. Here, the identification of two variants of A. baumannii ATCC 17978 that differ based on the presence of a 44-kb accessory locus, named AbaAL44 (A. baumannii accessory locus 44 kb), is described. Analyses of existing deposited data suggest that both variants are found in published studies of A. baumannii ATCC 17978 and that American Type Culture Collection (ATCC)-derived laboratory stocks comprise a mix of these two variants. Yet, each variant exhibits distinct interactions with the host in vitro and in vivo. Infection with the variant that harbors AbaAL44 (A. baumannii 17978 UN) results in decreased bacterial burdens and increased neutrophilic lung inflammation in a mouse model of pneumonia, and affects the production of interleukin 1 beta (IL-1ß) and IL-10 by infected macrophages. AbaAL44 harbors putative pathogenesis genes, including those predicted to encode a type I pilus cluster, a catalase, and a cardiolipin synthase. The accessory catalase increases A. baumannii resistance to oxidative stress and neutrophil-mediated killing in vitro. The accessory cardiolipin synthase plays a dichotomous role by promoting bacterial uptake and increasing IL-1ß production by macrophages, but also by enhancing bacterial resistance to cell envelope stress. Collectively, these findings highlight the phenotypic consequences of the genomic dynamism of A. baumannii through the evolution of two variants of a common type strain with distinct infection-related attributes.