Interdisciplinary Teams and Home-Based Medical Care: Secondary Analysis of a National Survey

This study examines the prevalence of home-based child care providers who report serving at least one child whom they identify as having a disability. Although many families choose home-based child care, researchers know very little about how many home-based providers care for young children with disabilities. Through secondary analysis of the National Survey of Early Care and Education (NSECE) data about home-based child care providers, we examined the prevalence and predictors of serving children with provider-reported disabilities among listed and unlisted home-based providers. Descriptive analyses showed that 21.7% of listed providers, 20.5% of unlisted paid providers, and 10.1% of unlisted unpaid providers reported serving at least one child whom they identified as having a disability. These providers reported relatively low rates of connecting families to outside resources and utilizing outside resources to support them in their work with children. Providers who reported higher enrollment and who received child care subsidies were more likely to report serving a child with a disability.

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COVID Challenges and Adaptations Among Home-Based Primary Care Practices: Lessons for an Ongoing Pandemic From a National Survey

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2021.05.016 ◽

2021 ◽

Author(s):

Christine S. Ritchie ◽

Naomi Gallopyn ◽

Orla Sheehan ◽

Shanaz Ahmed Sharieff ◽

Emily Franzosa ◽

...

Keyword(s):

Primary Care ◽

National Survey ◽

Home Based Primary Care ◽

Home Based ◽

Care Practices ◽

Primary Care Practices

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Geographic Concentration Of Home-Based Medical Care Providers

Health Affairs ◽

10.1377/hlthaff.2015.1437 ◽

2016 ◽

Vol 35 (8) ◽

pp. 1404-1409 ◽

Cited By ~ 21

Author(s):

Nengliang Yao ◽

Christine Ritchie ◽

Fabian Camacho ◽

Bruce Leff

Keyword(s):

Medical Care ◽

Care Providers ◽

Geographic Concentration ◽

Home Based

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The Impact of Nutritional Status and Body Mass Index on Rehabilitation Outcomes in Patients Receiving Home-Based Medical Care

World Nutrition Journal ◽

10.25220/wnj.v03.i2.0003 ◽

2020 ◽

Vol 3 (2) ◽

pp. 15

Author(s):

Kanako Eiwa ◽

Naomi Nakayama ◽

Yumi Takami ◽

Shuko Iwasaki ◽

Yoshinori Hino ◽

...

Keyword(s):

Body Mass Index ◽

At Risk ◽

Nutritional Status ◽

Medical Care ◽

Body Mass ◽

Functional Independence ◽

The Body ◽

Rehabilitation Outcomes ◽

Home Based ◽

The Impact

Background: Home-based medical care is expanding rapidly in Japan.Objectives: We aimed to identify the factors associated with outcomes of therapy in patients receiving home-visit rehabilitation.Methods: One hundred twenty-one patients receiving home-based rehabilitation were investigated. Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). The Functional Independence Measure (FIM) was employed to assess the activities of daily living (ADL). The body mass index (BMI), medical history, and orthopedic disease-related pain were also recorded. The primary outcome was the improvement in FIM scores in one year.Results: A total of 19 (17%) patients were malnourished and 58 (48%) were at risk of malnutrition. Malnourished patients had a lower FIM score at initiation than those at risk of malnutrition or with normal nutritional status. Only changes in patients’ BMI and MNA-SF scores over one year were significantly associated with improved FIM scores (p = 0.0079 and p = 0.0049, respectively). No association was noted with the other factors.Conclusions: This is the first report to demonstrate that changes in MNA-SF scores and BMI are significantly associated with rehabilitation outcomes in home-based care. Nutritional management is essential along with rehabilitation to improve ADL in the long-term home care setting.

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Promises and pitfalls of integrating home-based health services into Shanghai's elder-care system

Ageing and Society ◽

10.1017/s0144686x18001095 ◽

2018 ◽

Vol 40 (3) ◽

pp. 480-500

Author(s):

Yan-Yan Chen ◽

Honglin Chen ◽

Priscilla Song

Keyword(s):

Medical Care ◽

Elder Care ◽

Municipal Government ◽

Oldest Old ◽

Medical Services ◽

Ageing In Place ◽

Pilot Programme ◽

Care Giving ◽

Home Based ◽

Care System

AbstractFaced with the dramatic pace of population ageing, the Shanghai municipal government launched a pilot programme in 2013 designed to address this and to strengthen ageing-in-place arrangements by providing basic in-home medical services for residents above the age of 80. Yet after a two-year trial run, the ‘Home-Based Medical Care Scheme for the Oldest-Old’ (HBMCSOO) policy remained significantly under-utilised despite the increasing demand for medical services. Our multi-disciplinary research team of social workers and anthropologists identified two key factors impeding the implementation of home-based medical care services: (a) the distortion of policy implementation and (b) the inadequate professionalisation of community-based elder-care workers. Based on our evaluation of the pilot programme, the Shanghai municipal government made several practical adjustments to improve the subsequent city-wide policy implemented in 2016. While these changes mostly focused on minor adjustments to improve in-home medical services for the oldest-old, they represent an encouraging first step towards our call for a holistic integrated care system whose design and delivery takes into account local political and social contexts, including existing institutional infrastructure and cultural expectations about care-giving responsibilities. The challenges of implementing Shanghai's HBMCSOO policy ultimately provide instructive lessons on best practices for integrating medical and social services in order to improve ageing-in-place measures in diverse local settings around the world.

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Abstract 11: Targeted Training of a Motor-parietal Circuit Improves Its Behavioral Output

Stroke ◽

10.1161/str.48.suppl_1.11 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Steven C Cramer ◽

Robert Zhou ◽

Morgan Ingemanson ◽

John J Choi ◽

Katherine M Wu ◽

...

Keyword(s):

Primary Motor Cortex ◽

Brain Connectivity ◽

Secondary Analysis ◽

Visuomotor Learning ◽

Visuomotor Tracking ◽

Home Based ◽

Eeg Connectivity ◽

Hemiparetic Stroke ◽

Chronic Hemiparetic Stroke ◽

High Beta

Introduction: Emerging brain mapping methods measure function of individual brain circuits and have the potential to predict a patient’s gains and needs in the context of stroke rehabilitation. We recently described a motor-parietal circuit underlying visuomotor tracking and defined an EEG coherence measure (reflecting connectivity) that predicts visuomotor learning. Here we test the hypothesis that this EEG metric predicts visuomotor learning after stroke. Methods: After baseline dense-array resting EEG, patients with chronic hemiparetic stroke were provided with a home-based gaming system. During 9 half-hour training sessions, patients played games in which the stroke-affected arm tracked objects moving on the tabletop. Games were implemented using augmented reality, which we have found has advantages for motor training and in which virtual objects are projected into the real world and modified during game play. Results: Subjects (n=12) had affected arm Box&Blocks score of 15±12 and were 35±26 mo post-stroke. Visuomotor tracking improved significantly: on a standardized visuomotor test using the gaming system, scores increased from 60.5±11.5% to 74.0±3.2% (p=0.003). Gains were specific, as other behaviors were unchanged. Individual gains in visuomotor tracking score were predicted by the EEG connectivity metric from our prior study, coherence between leads overlying ipsilesional primary motor cortex (M1i) and ipsilesional lateral parietal region in the high beta (20-30 Hz) range, with higher connectivity predicting greater visuomotor tracking gains (r=0.61, p=0.037). This too was specific, as connectivity between M1i and other brain areas did not predict gains. Secondary analysis found that baseline visuomotor tracking scores correlated with several EEG connectivity measures, all inversely and all between M1i and contralesional regions. Conclusions: We found that (1) training that targets a specific brain circuit improves behavioral output of that circuit, and (2) an EEG measure of brain connectivity within that circuit predicts these behavioral gains--both with specificity. This approach may be useful for many neural circuits and their respective rehabilitation-related behaviors.

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Abstract TP318: The Circumstances and Consequences of Post-stroke Falls

Stroke ◽

10.1161/str.44.suppl_1.atp318 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Arlene A Schmid ◽

H. Klar Yaggi ◽

Nicolas Burrus ◽

Vincent McClain ◽

Charles Austin ◽

...

Keyword(s):

Medical Care ◽

Mental State ◽

Fall Prevention ◽

Secondary Analysis ◽

Stroke Recovery ◽

Large Trial ◽

Post Stroke ◽

Falling Asleep ◽

One Year ◽

The One

Introduction: Three-quarters of people with stroke sustain a fall. Fall risk and risk for injury persists into the chronics phases of stroke recovery. Currently, the circumstances surrounding post-stroke falls are not well understood; identifying these circumstances is a key step in the development of fall prevention programs. Likewise, the consequences of falls during the chronic phases of stroke are largely unexplored. Objectives: The objectives of the study were to identify the circumstances and consequences of post-stroke fall events. Methods: This is a secondary analysis of data derived from a large trial. To be included in the trial and these analyses, participants had to have survived a stroke and had a diagnosis of hypertension or blood pressure >140/90 mmHg. Demographics and stroke characteristics were recorded. Patients were asked about falls prospectively over the one-year study period. Once a fall event was identified, chart review and interviews were used to obtain information regarding circumstances and consequences of the fall. Fall circumstances were separated into intrinsic/personal and environmental categories including: falls with activity; falls with movement; falls due to trips or slips; falls related to a physical or mental state; location of the fall; and the season when the fall occurred. Consequences of falls were classified according to type of injury (laceration, fracture) and medical care received. Results: A total of 53 of the 225 (33%) participants reported a fall; 70% of falls occurred at home and 40% of falls were associated with impaired physical or mental state (e.g., falling asleep and falling out of a chair or inattention to tying shoes, or forgetting to use a device). Additionally, 21% of falls were associated with activities, 21% with mobility, and 34% with slips or trips. The majority of people who fell sustained an injury (72%); injuries ranged from bruising to fractures and 55% of those with an injury sought medical care (32% to emergency). Conclusion: Post-stroke falls are associated with an alarming rate of injury and healthcare utilization. Targeting mental and physical states may be key to fall prevention programming for people with chronic stroke.

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Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation

Prosthetics and Orthotics International ◽

10.1177/0309364620906272 ◽

2020 ◽

Vol 44 (2) ◽

pp. 52-59

Author(s):

Gordon Tao ◽

William C Miller ◽

Janice J Eng ◽

Heather Lindstrom ◽

Bita Imam ◽

...

Keyword(s):

Clinical Supervision ◽

Lower Limb ◽

Secondary Analysis ◽

Exercise Duration ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Experimental Session ◽

Supervised Training ◽

Session Time ◽

Home Based

Background: While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement. Objective: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. Study design: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. Methods: WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. Results: Participants: n=36 experimental, n=28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage ≥ 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity ( p<0.01) for experimental (0.25, IQR 0.00 -0.68) and control (0.18, IQR 0.00 -0.67) groups, with no different between groups ( p=0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 -1.41) between phases ( p=0.24); control showed lower (0.76, IQR 0.57 -1.08) ratios compared to experimental ( p=0.027). Conclusions: Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home. Clinical relevance This study provides context regarding when prosthesis users are more likely to use exergames such as Wii Fit for exercise therapy. Clinicians may consider our results when applying exergames in their practice or when developing new exergame intervention strategies.

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