Using Serologic Testing to Assess the Effectiveness of Outbreak Control Efforts, Serial Polymerase Chain Reaction Testing, and Cohorting of Positive Severe Acute Respiratory Syndrome Coronavirus 2 Patients in a Skilled Nursing Facility.

We characterized serology following a nursing home outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) where residents were serially tested by reverse-transcription polymerase chain reaction (RT-PCR) and positive residents were cohorted. When tested 46-76 days later, 24 of 26 RT-PCR-positive residents were seropositive; none of the 124 RT-PCR-negative residents had confirmed seropositivity, supporting serial SARS-CoV-2 RT-PCR testing and cohorting in nursing homes.

Establishment of a COVID-19 Recovery Unit in a Veterans Affairs Post-Acute Facility.

Coronavirus disease 2019 (COVID-19) is now an epidemic of global proportion, with major adverse impacts on older adults, persons with chronic diseases, and especially residents of long-term care facilities. This health catastrophe has challenged healthcare facilities' capacity to deliver care to not only COVID-19 patients but all patients who need hospital care. We report on a novel approach of utilizing long-term care beds at a Department of Veterans Affairs healthcare facility for managing recovering COVID-19 patients. J Am Geriatr Soc 68:2163-2166, 2020.

Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans - Los Angeles, California, 2020.

On March 28, 2020, two residents of a long-term care skilled nursing facility (SNF) at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS) had positive test results for SARS-CoV-2, the cause of coronavirus disease 2019 (COVID-19), by reverse transcription-polymerase chain reaction (RT-PCR) testing of nasopharyngeal specimens collected on March 26 and March 27. During March 29-April 23, all SNF residents, regardless of symptoms, underwent serial (approximately weekly) nasopharyngeal SARS-CoV-2 RT-PCR testing, and positive results were communicated to the county health department. All SNF clinical and nonclinical staff members were also screened for SARS-CoV-2 by RT-PCR during March 29-April 10. Nineteen of 99 (19%) residents and eight of 136 (6%) staff members had positive test results for SARS-CoV-2 during March 28-April 10; no further resident cases were identified on subsequent testing on April 13, April 22, and April 23. Fourteen of the 19 residents with COVID-19 were asymptomatic at the time of testing. Among these residents, eight developed symptoms 1-5 days after specimen collection and were later classified as presymptomatic; one of these patients died. This report describes an outbreak of COVID-19 in an SNF, with case identification accomplished by implementing several rounds of RT-PCR testing, permitting rapid isolation of both symptomatic and asymptomatic residents with COVID-19. The outbreak was successfully contained following implementation of this strategy.

What the resident meant to say: use of cognitive interviewing techniques to develop questionnaires for nursing home residents.

PURPOSE: Emphasis on consumer-centered care for frail and institutionalized older adults has increased the development and adaptation of surveys for this population. Conventional methods used to pretest survey items fail to investigate underlying sources of measurement error. However, the use of the cognitive interview (CI), a method for studying how respondents answer survey items, is not well established or documented in this population. This study demonstrates how CIs can be used to improve questionnaires intended for nursing home residents. DESIGN AND METHODS: CIs were conducted with 29 nursing home residents in order to identify potential problems with prospective survey items. We used scripted probes to standardize the interviews and adapted the Question Appraisal System to enumerate and classify the problems discovered. RESULTS: We fielded between one and five versions of each item in an iterative process that identified 61 item-specific problems. Additionally, residents' cognitive responses suggested that some screened their answers on the basis of perceived physical and environmental limitations, and some had difficulty answering items about preferences that fluctuate day to day. These findings led us to modify the items and response set to simplify the respondents' cognitive task. IMPLICATIONS: This study illustrates how CI techniques can be used to understand residents' comprehension of and response to survey items.

Effects of racial/ethnic discrimination on the health status of minority veterans.

As the veteran population becomes ethnically diverse, it is important to understand complex interrelationships between racism and health. This study examined the association between perceptions of discrimination and self-reported mental and physical health for Asian/Pacific Islander, African American, and Hispanic veterans. The data for this study come from the 2001 Veteran Identity Program Survey, which measured utilization of outpatient care, discrimination, and health status across three minority veteran groups. Multivariate regression methods were used to model self-reported mental and physical health on perceptions of discrimination controlling for demographic and socioeconomic characteristics. Findings revealed that racial/ethnic discrimination during military service was significantly associated with lower physical, but not mental health. Satisfaction with health care provider's sensitivity toward racial/ethnic background was significantly associated with better mental health. Findings highlight the importance of developing policies that address racial/ethnic discrimination during military service while providing health care services for veterans.

Knowledge and use of preventive health practices among Korean women in Los Angeles county.

BACKGROUND: The aims of this study are to determine (1) knowledge and use of preventive health practices, and (2) the relationship between acculturation and preventive health practices, in Korean women. METHODS: The data came from the 2000 Korean American Health Survey (KAHS), which includes 656 women. The dependent variables included use of pap smears, physical examinations and mammograms, and use and knowledge of self-breast examinations. Independent variables included demographic and acculturation variables. Logistic regression modeling was used to assess the role of acculturation on dependent variables. RESULTS: Some of the acculturation variables significantly predicted preventive practices. Being married (P < 0.0001) and insured (P < 0.05) were significantly associated with receipt of preventive services. A married Korean woman was more likely than an unmarried Korean woman to have a pap smear within 2 years (P < 0.0001), physical exam within 1 year (P < 0.0001), and perform self-breast examinations (P < 0.05). CONCLUSIONS: Factors related to acculturation influence use of preventive health practices by Korean American women, highlighting the need to consider cultural background in developing systems of care.

Time since immigration and health services utilization of Korean-American older adults living in Los Angeles County.

The aim of this study was to characterize ambulatory healthcare utilization of older Korean Americans and its association with length of time since immigration. It was hypothesized that older Korean Americans who were recent immigrants would use outpatient physician visits less often than early immigrants. The data are from the 2000 Korean-American Health Survey, which assessed the health status and medical needs of Korean Americans living in Los Angeles County. The dependent variable was the number of visits to a physician for check-up or consultation. Multivariate regression modeling was used to assess the influence of length of time since immigration on the dependent variable controlling for predisposing, enabling, and need variables for a sample of 208 Koreans Americans aged 65 and older. Results indicated that high school education in Korea and health insurance status were significant predictors of number of visits to a physician during the previous year (P<.05). The main variable of interest, the number of years living in the United States, approached significance at P=.09. It was concluded that enabling variables such as education and health insurance significantly influenced use of healthcare services in the older Korean-American population. The lack of studies regarding older minority populations and their access to healthcare further highlight theneed not only to characterize the access of these often-vulnerable populations, but also to generate interest for further studies.

The health and health status of older Korean Americans at the 100-year anniversary of Korean immigration.

There are 28 subgroups in the Asian American Pacific Islander (AAPI) ethnic population. They accounted for 12.5 million persons in the year 2002 or 4.4% of the non-institutionalized US population (Reeves&Bennett, 2003). It is a rapidly growing population in the United States, particularly in Southern California. The Korean American population is the fifth largest ethnic group in the heterogeneous AAPI population. Despite their increasing numbers there lacks data regarding the health status and healthcare utilization of the AAPI population. The aim of this study is to characterize the health status and healthcare utilization of an Asian American ethnic group, the Korean Americans. The data are from the 2000 Korean American Health Survey (KAHS). This survey of 1,660 Korean Americans living in Los Angeles County assessed their health status and medical needs and composed the largest sample recruited for a health study on Korean Americans to date. For the study 208 Koreans Americans aged 65 and over were reported. Descriptive statistics were performed to illustrate the health status and needs of the Korean American older persons. Over one-half of the sample, 69% of the Korean American older persons in the study reported a fair or poor health status. This is in stark contrast to a survey conducted by the Commonwealth Fund, which found that 17% of the minorities and 30% of the Korean Americans rated their health as fair or poor (Commonwealth Fund, 2002). With regards to access to healthcare 21% of the Korean American older adults in the sample lacked health insurance and 31% had never visited a medical doctor within the last 12 months for a check up or consultation. It is felt that an individual's chance of being uninsured varies across the life span and that people 65 years and older have a minimal likelihood of being uninsured due to Medicare (IOM, 2001). However when looking at certain subgroups higher percentages of uninsured are revealed. One out of every three Koreans Americans in the US is uninsured compared to 21% of all AAPI and 14% non-Latino whites. In California the proportion is even higher with almost half of all Koreans being uninsured (Brown et al. 2001). This type of discrepancy compounds the "Model Minority Myth" that AAPI population is a successful minority group and do not have barriers to health care (Chen et al. 1995). One study examining health services research status in the AAPI found that Korean Americans were one of the most understudied populations relative to their size (Andersen et al. 1995). Since the AAPI population and subgroups are often not included in health services research this results in "myths" or inaccuracies regarding their health. Studies of AAPI populations are needed to provide information regarding the health of the population, educate health care providers to assist them in the care of ethnic populations and seek interventions to remove health disparities in minority populations.

Living alone and outpatient care use by older veterans.

In nonveteran older adults, living alone influences outpatient care use, but its importance in the veteran population has not been well studied. The aims of this study are to describe the use of outpatient care by older veterans who live alone versus those who live with others and determine whether living alone influences outpatient use by older veterans. The data come from the 2001 Veteran Identity Program Survey designed to measure Department of Veterans Affairs (VA) and non-VA outpatient care use. Univariate and bivariate analyses were conducted to examine distributional properties, associations, and subgroup differences in outpatient care use. Poisson regression was used to assess the role of living alone on outpatient care use, controlling for predisposing, other enabling, and need factors. Results found that older veterans who use the VA, whether they live alone or not, have similar numbers of VA outpatient visits. Older veterans who use VA and non-VA facilities and who live alone have greater total outpatient visits than those who live with others. Regression results indicate that living alone is a predictor of VA routine medical visits, VA prescription refill visits, and total VA and non-VA outpatient visits but does not influence VA emergency room visits. These findings suggest that living alone is associated with differences in outpatient care use by older veterans. It is important for the VA to understand this relationship with the aim of developing interventions to improve access, effectiveness, and efficiency of health services for older veterans.