scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults With Disabilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 78-78
Author(s):  
Joanne Spetz ◽  
Jacqueline Miller ◽  
Connie Kwong ◽  
Laura Wagner
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
San Francisco ◽  
Comparison Group ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for the purchase of home care services by middle-income adults with disabilities in San Francisco to support aging in place. Enrollees had income below the area median and made copayments based on household income. The mixed-methods evaluation of the program incorporated administrative records, surveys of clients and comparison group members, surveys of unpaid caregivers, surveys of paid care providers, and focus groups with clients and unpaid caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons between client and comparison groups and multivariate regressions. An economic analysis was conducted to learn whether changes in costs associated with reduced health care utilization were greater than the costs of the program. Results indicated statistically significant positive changes in client ratings of personal and financial stress, but not in the composite quality of life score. There were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. Similar changes were not found in the comparison group. The focus group data supported the findings regarding personal and financial stress and indicated that clients and their caregivers perceived quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services. Due to its positive impacts, San Francisco has made Support at Home a permanent program.

scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 355-356
Author(s):  
Joanne Spetz ◽  
Laura Wagner ◽  
Jacqueline Miller ◽  
Susan Chapman ◽  
Connie Kwong
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
Informal Caregivers ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Life Questionnaire ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for home care services by middle-income adults with disabilities in San Francisco to support aging in place. This presentation reports the results of the mixed-methods evaluation of the program, which incorporated administrative records, surveys of clients and comparison group members, surveys of informal caregivers of clients, surveys of the care providers hired by clients, and focus groups with clients and with informal caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons and comparisons of changes between the client and comparison groups. Multivariate regression analyses were conducted to control for demographic differences between the groups. An economic analysis was conducted to learn whether changes in costs associated with medical appointments, emergency department visits, and hospitalizations were greater than the costs of the program, including both voucher and administrative costs. Results indicated statistically significant positive changes in personal stress and financial stress, but not in the composite quality of life score. There also were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. The focus group data supported the findings regarding personal and financial stress, and also indicated that clients and their caregivers perceived positive quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services.

scholarly journals THE IMPACT OF THE R3 PROGRAM ON SERVICE UTILIZATION, COSTS, AND QUALITY OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S777-S777
Author(s):  
Marc A Cohen ◽  
Jennifer Hefele ◽  
Edward Miller ◽  
Pamela Nadash ◽  
Natalie Shellito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Service Utilization ◽  
Comparison Group ◽  
Skilled Nursing Facility ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Quasi Experimental ◽  
The Impact

Abstract Relatively few housing with services evaluations employ rigorous multiple group quasi-experimental designs rather than simple before/after research designs. This study employs a pre-post experimental design with a comparison group to analyze whether the R3 program led to reductions in certain key utilization measures, including emergency department visits, inpatient hospitalizations, ambulance usage, and skilled nursing facility admissions, over 18 months. Also examined is whether resident quality of life indicators changed over the period. Data derive from assessments with 410 residents in four intervention sites and 227 residents in five comparison group sites. Also obtained was data on emergency department transfers from first responder services and Medicare fee-for-service data from the local quality improvement organization. Results suggest that the program has positive implications for service utilization, costs, and quality of life. Early detection and intervention inherent in the R3 program may improve resident quality of life while lowering service utilization and costs.

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

Preoperative Nomograms Predict Patient-Specific Cervical Spine Surgery Clinical and Quality of Life Outcomes

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 104-113 ◽  
Author(s):  
Daniel Lubelski ◽  
Vincent Alentado ◽  
Amy S Nowacki ◽  
Michael Shriver ◽  
Kalil G Abdullah ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Emergency Department Visits ◽  
Patient Specific ◽  
Median Income ◽  
Cervical Spine Surgery ◽  
Presenting Symptoms

Abstract BACKGROUND Clinical and quality of life (QOL) outcomes vary depending on the patient's demographics, comorbidities, presenting symptoms, pathology, and surgical treatment used. While there have been individual predictors identified, no comprehensive method incorporates a patient's complex clinical presentation to predict a specific individual postoperative outcome. OBJECTIVE To create tool that predicts patient-specific outcomes among those undergoing cervical spine surgery. METHODS A total of 952 patients at a single tertiary care institution who underwent anterior or posterior cervical decompression/fusion between 2007 and 2013 were retrospectively reviewed. Outcomes included postoperative emergency department visit or readmission within 30 d, reoperation within 90 d for infection, and changes in QOL outcomes. Nomograms were modeled based on patient demographics and surgical variables. Bootstrap was used for internal validation. RESULTS Bias-corrected c-index for emergency department visits, readmission, and reoperation were 0.63, 0.78, and 0.91, respectively. For the QOL metrics, the bias-corrected adjusted R-squared was EQ-5D (EuroQOL): 0.43, for PHQ-9 (Patient Health Questionnaire-9): 0.35, and for PDQ (Pain/Disability Questionnaire): 0.47. Variables predicting the clinical outcomes varied, but included race and median income, body mass index, comorbidities, presenting symptoms, indication for surgery, surgery type, and levels. For the QOL nomograms, the predictors included similar variables, but were significantly more affected by the preoperative QOL of the patient. CONCLUSION These prediction models enable referring physicians and spine surgeons to provide patients with personalized expectations regarding postoperative clinical and QOL outcomes following a cervical spine surgery. After appropriate validation, use of patient-specific prediction tools, such as nomograms, has the potential to lead to superior spine surgery outcomes and more cost effective care.

scholarly journals What is the Latest on Catheter Ablation of Atrial Fibrillation?

2018 ◽  
Vol 13 (SP1) ◽  
Author(s):  
Jason Andrade ◽  
Marc Dyall ◽  
Laurent Macle
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Clinical Practice ◽  
Catheter Ablation ◽  
Direct Costs ◽  
Cardiac Performance ◽  
Emergency Department Visits ◽  
Healthcare Expenditures

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia observed in clinical practice, affecting 1-2% of the general population. AF is associated with reductions in quality of life, functional status, cardiac performance, and survival. In addition, AF accounts for 1.0-2.7% of total annual healthcare expenditures, with a sizeable proportion of these expenses attributed to direct costs associated with emergency department visits and acute care hospitalisation.

scholarly journals Stone size and quality of life: A critical evaluation after extracorporeal shock wave lithotripsy

2015 ◽  
Vol 87 (3) ◽  
pp. 227 ◽  
Author(s):  
Cahit Sahin ◽  
A. Cihangir Cetinel ◽  
Bilal Eryildirim ◽  
Murat Tuncer ◽  
Gokhan Faydaci ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Critical Evaluation ◽  
Emergency Department Visits ◽  
Stone Size ◽  
Extracorporeal Shock Wave ◽  
Group 3 ◽  
Group 2

Objectives: To evaluate the quality of life (QoL) of the patients after extracorporeal shockwave lithotripsy (ESWL) on a treated stone size related basis. Methods: 90 patients undergoing ESWL for kidney stones were divided into three groups; Group 1 (n: 30, ≤ 10mm), Group 2 (n: 28, 11 mm- ≤ 20 mm) and Group 3 (n: 32, 20- 25 mm). During 3- months follow-up, outcome of the procedure, number of cases with emergency department visits, analgesic required, re-tretatment rates, additional procedures and the changes in the QoL were evaluated. Results: the number of emergency department visits and mean analgesic need; re-treatment rates and additional procedures were significantly higher in Group 3. Evaluation of the QoL scores in three groups showed that cases with larger stone still had lower scores during 3-month evaluation. Conclusions: Stone size could help us to predict the possible impact of ESWL on the QoL and depending on the size of the stone treated, a well planned indication and effective management possibly by an experienced urologist could limit the changes in the QoL of the patients.

scholarly journals Quality of life of caregivers of cancer patients in home palliative care: a non-interventional study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Faggian ◽  
S Favero ◽  
D Gregori ◽  
M Martinato
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patient ◽  
Home Care ◽  
Continuity Of Care ◽  
Physical Stress ◽  
Private Life ◽  
Phone Call ◽  
Average Score

Abstract Background caregivers of home-cared cancer patient during palliative phase are often under psychological and physical pressure. This can lead to a low level quality of life (QoL). This study assesses the QoL of this type of caregiver, more specifically it aims to outline which factors (age, type of palliative care, amount of time spent daily with the patient) affect positively or negatively the QoL score. Methods The AC-QoL questionnaire has been completed by 25 caregivers of oncological patients in home care in north-eastern Italy. The questionnaire is made of 40 items divided into 8 subjects: support in care, choice of care, stress, economic issues, personal growth, sense of value, care skills and personal satisfaction. It has been administered during a home visit or during a follow-up phone call. Results The average score obtained is 71/120, which means a medium level of QoL. The factors which worsen the QoL are the psychological and physical stress (average score 5/15) and restrictions on caregivers' private life (average score 6/15). No significant differences in the QoL of the caregivers are related to social and personal variables (such as age, working condition, relationship with the patient, type of palliative care, amount of time spent daily with the patient). Conclusions These caregivers play a fundamental role in the management of an appropriate continuity of care and their health and QoL are important. Stress and restrictions on private life are the factors which worsen QoL, that's why nurses should evaluate the caregivers' wellbeing during home-visits. Caregivers usually feel able to offer adequate assistance if they have been adequately trained to by healthcare professionals: nurses should provide every useful tool to aloud the caregiver to feel able of and comfortable providing assistance to his/her relative trough an “empowerment process”. Key messages Caregiver of cancer patient in charge of home palliative care is fundamental for an appropriate continuity of care and his health and quality of life (QoL) are important to provide good assistance. Psycho-physical stress and restrictions on private life worsen QoL. Caregiver’s wellbeing should be assessed and useful tools should be provided by home care nurses to ease caregivers’ job.

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