Impact of school-based health centers on children with asthma.

PURPOSE: To quantitatively assess the impact of school-based health centers (SBHCs) on hospitalization and emergency department (ED) visits for children with asthma. METHODS: The study was conducted at four SBHC intervention school districts and two comparable non-SBHC school districts in Greater Cincinnati, Ohio. A longitudinal quasi-experimental time-series repeated measures design was used with a study period from 1997 to 2003. Children with asthma with at least 2 years of continuous enrollment who had medical claims for asthma diagnosis and antiasthmatic medications were selected. The primary data sources were student enrollment data from the schools and the Ohio Medicaid claims database. Generalized estimating equation (GEE) analysis and analysis of covariance were used to assess the intervention effect before and after the SBHC program. RESULTS: Asthma was one of the major diseases for SBHC encounters. Major prescription drugs that SBHC staff managed for children with asthma included albuterol, montelukast, fluticasone, budesonide, and triamcinolone. Of 273 children (196 in SBHC schools and 77 in non-SBHC schools), 42% were female, 41.7% African-Americans, and the average age was 8.2 years. After the opening of the SBHC, relative risks of hospitalization and ED visits in the SBHC group decreased 2.4-fold and 33.5%, respectively. The cost of hospitalization per child decreased significantly over time for children in SBHC schools (F = 4.115, p = .044). After SBHCs opened, cost of hospitalization decreased for African-American children (F = 5.198, p = .023). Costs of ED visits for children in SBHC schools were significantly lower than children in non-SBHC schools (F = 19.8, p < .0001). CONCLUSIONS: The risk of hospitalization and ED visits for children with asthma decreased significantly with SBHC programs. The potential cost-savings for hospitalization was estimated as 970 dollars per child.

Special care units: meeting the needs of cognitively impaired persons.

1. Alzheimer's disease (AD) is the fourth leading cause of death of older persons. Families frequently turn to nursing homes to provide the care that they are unable to provide during the later stages of the disease. 2. Sloane and Mathew concluded that special care units resulted in better care based on appearance, little difference in weight loss, similar range of services to traditional units, higher amount of interaction with residents more often out of their room, greater mobility, fewer medications, less physical restraint, and similar use of chemical restraints. 3. Alzheimer's disease does not affect an individual only; it affects a family. Effective programming includes the family. From the initial contact with the institution through placement on the special care unit--and often beyond the death of the resident--families are supported by the staff.

The role of the nursing home in nursing research of the elderly.

The greatest repository of knowledge of the elderly lies in the nursing home setting. Nurses who work in nursing homes acknowledge that the knowledge base that directs their practice is gerontological knowledge and over time they have evolved the most sophisticated care for older persons. Much of this care has evolved in trial and error response to needs. Many of the interventions have not been tested in rigorous research and therefore are difficult to justify in an atmosphere of cost cutting. Nursing home nurses have, therefore, a responsibility to be forerunners in the generation, testing and dissemination of the body of gerontological nursing knowledge to guide effective and efficient nursing practice with older persons. In a time of decreased resources this is no small challenge. To suggest approaches to encourage long term care research this article will explore the literature in this area, relate knowledge gained from the teaching nursing home projects and share the experience of a Director of Nursing in fostering research in a teaching nursing home setting without outside funding.

Sharing the legacy. Hospice care principles for terminally ill elders.

Hospice care is usually chosen as the preferred mode of care when the patient and family judge that the burdens of aggressive treatment are greater than the benefits that can be expected. Hospice treatment is directed at controlling pain, relieving other symptoms, and focusing on the special needs of the hospice patient and the patient's family. The objective of hospice care is to prevent breakthrough pain while maintaining an acceptable level of consciousness. Family teaching in hospices is centered around appropriate responses to physical and emotional/spiritual/mental signs and symptoms of approaching death.