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Author: Lianlian Kim
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
With the aging population, the number of older Americans with dementia is expected to grow rapidly. Patients with dementia are reported to have higher health care utilization and cost compared to those without dementia, or patients with heart disease and cancer. Although dementia is a complex neuropsychiatric illness often accompanied by other medical comorbidities, most care for patients with dementia is provided within primary care. Continuity of care (COC) has been regarded a core attribute of primary care. Recent healthcare reforms promote COC through the Patient Protection and Affordable Care Act's Patient-Centered Medical Home, accountable care organization, and Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT). This dissertation aims to examine the causal impact of continuity of care on health care utilization and cost among community-dwelling older veterans living with dementia. This study uses VHA (enrollment, inpatient and outpatient records, purchased care claims) and Medicare (enrollment and all claims) data linked at the veteran level in fiscal year (FY) 2014-2015 to comprehensively measure COC, health care utilization and cost for veterans. The study cohort is community-dwelling veterans with dementia aged 66 and older and enrolled in Traditional Medicare. This study has three specific aims: (1) to determine the impact of COC on health care cost; (2) to determine the impact of COC on hospitalization; and (3) to determine the impact of COC on successful discharge to community after index hospitalization among community-dwelling older veterans with dementia. COC is measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale which measures the dispersion of the veteran's outpatient visits across all primary care providers and dementia-related specialists. This study uses a linear model of health care cost and a probit model of hospitalization and successful community discharge after hospitalization in FY 2015 explained by COC and other covariates (socio-demographics, socio-economic status, risk factors and market characteristics) in FY 2014. An instrumental variable approach is applied to address the endogeneity of COC and health care utilization and cost. The instrument is whether veteran changes residence by more than 10 miles in FY 2014. Results show that better COC results in lower total VHA and Medicare cost; and the mechanism can be explained by higher non-institutional medical and social long-term care cost (e.g. home-based primary care and adult day health care) and lower institutional cost (i.e. acute inpatient, emergency department, and nursing home). Better COC results in less acute hospitalizations, and this effect primarily comes from the reduction in hospitalization for neuro-psychiatric diseases/disorders but not other hospitalization reasons or potentially preventable hospitalization. Better COC results in higher probability of successful community discharge following hospitalization. In conclusion, this dissertation finds that better COC results in lower total health care cost, less hospitalization and greater probability of successful community discharge after hospitalization among community-dwelling older veterans living with dementia. These findings support the important role of COC in health care systems and thus supporting efforts to improve COC as a means to reducing health care cost, curbing hospitalization and increasing successful community discharge after hospitalization among older adults with dementia.
Author: Lianlian Kim
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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Book Description
With the aging population, the number of older Americans with dementia is expected to grow rapidly. Patients with dementia are reported to have higher health care utilization and cost compared to those without dementia, or patients with heart disease and cancer. Although dementia is a complex neuropsychiatric illness often accompanied by other medical comorbidities, most care for patients with dementia is provided within primary care. Continuity of care (COC) has been regarded a core attribute of primary care. Recent healthcare reforms promote COC through the Patient Protection and Affordable Care Act's Patient-Centered Medical Home, accountable care organization, and Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT). This dissertation aims to examine the causal impact of continuity of care on health care utilization and cost among community-dwelling older veterans living with dementia. This study uses VHA (enrollment, inpatient and outpatient records, purchased care claims) and Medicare (enrollment and all claims) data linked at the veteran level in fiscal year (FY) 2014-2015 to comprehensively measure COC, health care utilization and cost for veterans. The study cohort is community-dwelling veterans with dementia aged 66 and older and enrolled in Traditional Medicare. This study has three specific aims: (1) to determine the impact of COC on health care cost; (2) to determine the impact of COC on hospitalization; and (3) to determine the impact of COC on successful discharge to community after index hospitalization among community-dwelling older veterans with dementia. COC is measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale which measures the dispersion of the veteran's outpatient visits across all primary care providers and dementia-related specialists. This study uses a linear model of health care cost and a probit model of hospitalization and successful community discharge after hospitalization in FY 2015 explained by COC and other covariates (socio-demographics, socio-economic status, risk factors and market characteristics) in FY 2014. An instrumental variable approach is applied to address the endogeneity of COC and health care utilization and cost. The instrument is whether veteran changes residence by more than 10 miles in FY 2014. Results show that better COC results in lower total VHA and Medicare cost; and the mechanism can be explained by higher non-institutional medical and social long-term care cost (e.g. home-based primary care and adult day health care) and lower institutional cost (i.e. acute inpatient, emergency department, and nursing home). Better COC results in less acute hospitalizations, and this effect primarily comes from the reduction in hospitalization for neuro-psychiatric diseases/disorders but not other hospitalization reasons or potentially preventable hospitalization. Better COC results in higher probability of successful community discharge following hospitalization. In conclusion, this dissertation finds that better COC results in lower total health care cost, less hospitalization and greater probability of successful community discharge after hospitalization among community-dwelling older veterans living with dementia. These findings support the important role of COC in health care systems and thus supporting efforts to improve COC as a means to reducing health care cost, curbing hospitalization and increasing successful community discharge after hospitalization among older adults with dementia.
Author: Ronda Hughes
Publisher: Department of Health and Human Services
ISBN:
Category : Medical
Languages : en
Pages : 592
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Book Description
"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/
Author: Lars-Christer Hydén
Publisher: Bloomsbury Publishing
ISBN: 113759375X
Category : Social Science
Languages : en
Pages : 192
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Book Description
Traditionally, dementia has been defined primarily in terms of loss: loss of cognitive and communicative competencies, loss of identity, loss of personal relationships. People living with dementia have been portrayed as increasingly dependent on others, with their loved ones seen more as care givers than as spouses, children and relatives. However, in the last two decades this view of the person living with dementia as an 'empty vessel' has been increasingly challenged, and the focus has shifted from one of care to one of helping people to live with dementia. With contributions from an international range of expert authors, Living with Dementia strongly advocates this new perspective through in-depth discussion of what people with dementia and their loved ones can do, and how they can actively make use of remaining resources. Topics covered include: - How to involve people with dementia in collaborative activities in the home, and the benefits this has on their cognitive and communicative abilities. - Ways in which identity can be presented and preserved through storytelling, and the impact on identity of moving from home into residential care. - The benefits of a 'citizenship' approach to dementia: of recognising that a person living with dementia is an active agent, with the right to self-determination and the ability to exert power over their own lives. This important new contribution to the dementia debate is truly enlightening reading for students across the full range of health and social care disciplines, and offers a fresh perspective to existing practitioners and those who care for people with dementia.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309131952
Category : Medical
Languages : en
Pages : 316
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Book Description
As the first of the nation's 78 million baby boomers begin reaching age 65 in 2011, they will face a health care workforce that is too small and woefully unprepared to meet their specific health needs. Retooling for an Aging America calls for bold initiatives starting immediately to train all health care providers in the basics of geriatric care and to prepare family members and other informal caregivers, who currently receive little or no training in how to tend to their aging loved ones. The book also recommends that Medicare, Medicaid, and other health plans pay higher rates to boost recruitment and retention of geriatric specialists and care aides. Educators and health professional groups can use Retooling for an Aging America to institute or increase formal education and training in geriatrics. Consumer groups can use the book to advocate for improving the care for older adults. Health care professional and occupational groups can use it to improve the quality of health care jobs.
Author: Kaveh G. Shojania
Publisher:
ISBN: 9781587632594
Category : Disaster hospitals
Languages : en
Pages : 7
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Book Description
Author: Francisco José Tarazona Santabalbina
Publisher: Mdpi AG
ISBN: 9783036518237
Category : Medical
Languages : en
Pages : 298
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Book Description
In recent decades, life expectancy has been increasing. This is a historical milestone in the history of humanity. We have never lived so long before. In these circumstances, giving the best care to older adults efficiently is one of the greatest challenges of developed countries. This book explores different initiatives that result in the improvement of health conditions of older adults, such as multicomponent physical exercise programs, interventions that try to avoid loneliness and social isolation, and multidisciplinary assessment, and the treatment of frailty and other geriatric syndromes, of the elderly in various settings such as the Emergency Unit, Orthogeriatrics, and Oncogeriatrics. This book offers different manuscripts to readers, each trying to improve life satisfaction, quality of life, and life expectancy in older adults in different scenarios. It is up to us to achieve these goals. We are sure that these interesting chapters will contribute to improving clinical practices. Following the completion of the Special Issue "Health Care for Older Adults" for the international Journal of Environmental Research and Public Health, the Guest Editors felt the satisfaction of having reached 18 published manuscripts and the possibility of transforming this volume into a book. This book was born from the need to show how health and social advances have increased human longevity as never before. We live longer, knowing more and more the epigenetic mechanisms of this longevity, as extended aging also coexists with the least favorable aging trajectories. Among them, a syndrome stands out from the gerontological and geriatric perspective: frailty. Due to the pandemic, a social problem has increased its presence in clinical practice: ageism. Older adults have found it difficult to access the necessary clinical resources due to the simple matter of age. However, at this moment, we are able to detect and to reverse frailty. In the same way, we should aim to prevent loneliness and social isolation, involved in social frailty. Geriatric syndromes are underdiagnosed and undertreated, but clinical and geriatric knowledge provide diagnostic tools and non-pharmacological approaches to prevent and to treat them. All health professionals working together in an interdisciplinary team could improve the clinical practices to develop a quality health care for older adults, improving their life satisfaction and quality of life perception too.
Author: Kamran Sartipi
Publisher: BoD – Books on Demand
ISBN: 178985881X
Category : Health & Fitness
Languages : en
Pages : 150
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Book Description
Technologically supported healthcare management is beginning to take center stage as advances occur in many aspects of healthcare, involving big data, artificial intelligence, and improved user interfaces. This volume provides a perspective on a number of such advances, ranging from homecare with remote network support and primary homecare to telemedicine application for pediatric cardiology. A special section with chapters on Clinical Decision Support Systems (CDSS) addresses topics in improved human interfaces, intelligent support for better quality home and institutional care, effective big data visualization for decision-makers, and gathering data from multiple sources to support the battle against resistant bacteria.
Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309221277
Category : Medical
Languages : en
Pages : 350
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Book Description
In the United States, chronic diseases currently account for 70 percent of all deaths, and close to 48 million Americans report a disability related to a chronic condition. Today, about one in four Americans have multiple diseases and the prevalence and burden of chronic disease in the elderly and racial/ethnic minorities are notably disproportionate. Chronic disease has now emerged as a major public health problem and it threatens not only population health, but our social and economic welfare. Living Well with Chronic Disease identifies the population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals who are at risk of developing a chronic disease and those with one or more diseases. The book recommends that all major federally funded programmatic and research initiatives in health include an evaluation on health-related quality of life and functional status. Also, the book recommends increasing support for implementation research on how to disseminate effective longterm lifestyle interventions in community-based settings that improve living well with chronic disease. Living Well with Chronic Disease uses three frameworks and considers diseases such as heart disease and stroke, diabetes, depression, and respiratory problems. The book's recommendations will inform policy makers concerned with health reform in public- and private-sectors and also managers of communitybased and public-health intervention programs, private and public research funders, and patients living with one or more chronic conditions.
Author:
Publisher:
ISBN:
Category : Medicine
Languages : en
Pages : 1496
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Book Description
Author: Michael L. Malone
Publisher: Springer
ISBN: 3319160680
Category : Medical
Languages : en
Pages : 321
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Book Description
This book describes geriatrics practice models that are used to guide the care of older adults, allowing seniors to remain at home, prevent functional disability and preserve quality of life. The models include specific interventions which are performed by health care workers to address the needs of older persons and their caregivers. These models respect patient values, consider patient safety and appreciate psychosocial needs as well. Divided into six parts that discuss hospital-based models of care, transitions from hospital to home, outpatient-based models of care and emergency department models of care, this text addresses the needs of vulnerable patients and the community. Geriatric Models of Care is an excellent resource for health care leaders who must translate these programs to address the needs of the patients in their communities.
