scholarly journals Using Population-Level Data to Assess Need for and Use of Long-Term Services and Supports in California

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 504-504
Author(s):  
Kathryn Kietzman ◽  
Lei Chen ◽  
Rebecca Allen
Keyword(s):  
Service Use ◽  
Population Level ◽  
Routine Care ◽  
California Health Interview Survey ◽  
Care Needs ◽  
Level Data ◽  
Share Data ◽  
Report Data ◽  
Services And Supports

Abstract In response to aging and disability stakeholder advocacy in California, the state’s 2018-19 budget included support for the development of a study of Californians with needs for long-term services and supports (LTSS). Existing data on LTSS most typically represents those who already use specific programs or services. Yet many programs do not uniformly collect and report data, or have little capacity to share data across different delivery systems. In response to these gaps, we developed a 15-minute follow-on survey to the 2019-2020 California Health Interview Survey (CHIS), gathering statewide population-level data to assess LTSS needs and use by Californians 18 years of age and older. This paper reports on preliminary findings from the 2019 CHIS-LTSS survey conducted with a sample of 1097 respondents. Screening questions identified respondents reporting difficulties with concentrating, remembering, or making decisions (60%), performing basic daily activities such as dressing or bathing (26%), or getting out of the house to shop or to see the doctor (52%). Nearly half of respondents (45%) reported needing help with routine care needs while 16% needed help with personal care needs. Additional findings illustrate specific LTSS needs, service use, consequences of unmet needs, financial concerns, and consumer experiences. At a time when California policy makers, program planners, and advocates are engaged in implementing a 10-year Master Plan for Aging, these findings can be used to identify and address gaps in the types of services and supports that are essential to meet the LTSS needs of older adults and people with disabilities.

scholarly journals Methodology of Natsal-COVID Wave 1: a large, quasi-representative survey with qualitative follow-up measuring the impact of COVID-19 on sexual and reproductive health in Britain

2021 ◽  
Vol 6 ◽  
pp. 209
Author(s):  
Emily Dema ◽  
Andrew J Copas ◽  
Soazig Clifton ◽  
Anne Conolly ◽  
Margaret Blake ◽  
...  
Keyword(s):  
General Population ◽  
Reproductive Health ◽  
Sexual Behaviour ◽  
Sexual And Reproductive Health ◽  
Service Use ◽  
Population Data ◽  
Population Level ◽  
Level Data ◽  
The Impact

Background: Britain’s National Surveys of Sexual Attitudes and Lifestyles (Natsal) have been undertaken decennially since 1990 and provide a key data source underpinning sexual and reproductive health (SRH) policy. The COVID-19 pandemic disrupted many aspects of sexual lifestyles, triggering an urgent need for population-level data on sexual behaviour, relationships, and service use at a time when gold-standard in-person, household-based surveys with probability sampling were not feasible. We designed the Natsal-COVID study to understand the impact of COVID-19 on the nation’s SRH and assessed the sample representativeness. Methods: Natsal-COVID Wave 1 data collection was conducted four months (29/7-10/8/2020) after the announcement of Britain’s first national lockdown (23/03/2020). This was an online web-panel survey administered by survey research company, Ipsos MORI. Eligible participants were resident in Britain, aged 18-59 years, and the sample included a boost of those aged 18-29. Questions covered participants’ sexual behaviour, relationships, and SRH service use. Quotas and weighting were used to achieve a quasi-representative sample of the British general population. Participants meeting criteria of interest and agreeing to recontact were selected for qualitative follow-up interviews. Comparisons were made with contemporaneous national probability surveys and Natsal-3 (2010-12) to understand bias. Results: 6,654 participants completed the survey and 45 completed follow-up interviews. The weighted Natsal-COVID sample was similar to the general population in terms of gender, age, ethnicity, rurality, and, among sexually-active participants, numbers of sexual partners in the past year. However, the sample was more educated, contained more sexually-inexperienced people, and included more people in poorer health. Conclusions: Natsal-COVID Wave 1 rapidly collected quasi-representative population data to enable evaluation of the early population-level impact of COVID-19 and lockdown measures on SRH in Britain and inform policy. Although sampling was less representative than the decennial Natsals, Natsal-COVID will complement national surveillance data and Natsal-4 (planned for 2022).

scholarly journals A deliberative study of public attitudes towards sharing genomic data within NHS genomic medicine services in England

2020 ◽  
Vol 29 (7) ◽  
pp. 702-717
Author(s):  
Lamiece Hassan ◽  
Ann Dalton ◽  
Carrie Hammond ◽  
Mary Patricia Tully
Keyword(s):  
Public Attitudes ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Genomic Data ◽  
Routine Care ◽  
Service Development ◽  
The Public ◽  
Research Activities ◽  
Share Data

Whole genome (DNA) sequencing is becoming part of routine care healthcare in England. Genomic data are most useful when pooled with other patients’ data, meaning that clinicians may need to share data to effectively treat patients. We ran deliberative focus groups to explore views among 44 patients and members of the public about proposals for wider genomic data sharing for clinical care. Participants were briefed about genomic medicine and engaged in group and individual exercises to deliberate on the benefits and risks of using genomic data. Findings showed that participants supported wider sharing of genomic data within health services and naturally linked care and research activities. Nonetheless, they were concerned about managing flows of information to protect patient confidentiality and guard against unauthorised uses, now and over the long-term. Ongoing conversations with the public are needed to determine appropriate uses of genomic data and safeguards to inform service development.

scholarly journals Hurricane-induced demographic changes in a non-human primate population

2020 ◽  
Vol 7 (8) ◽  
pp. 200173
Author(s):  
Dana O. Morcillo ◽  
Ulrich K. Steiner ◽  
Kristine L. Grayson ◽  
Angelina V. Ruiz-Lambides ◽  
Raisa Hernández-Pacheco
Keyword(s):  
Population Level ◽  
Matrix Population Models ◽  
Individual Level ◽  
Animal Populations ◽  
Level Data ◽  
Climatic Event ◽  
Free Ranging ◽  
Human Primate ◽  
Population Fitness

Major disturbance events can have large impacts on the demography and dynamics of animal populations. Hurricanes are one example of an extreme climatic event, predicted to increase in frequency due to climate change, and thus expected to be a considerable threat to population viability. However, little is understood about the underlying demographic mechanisms shaping population response following these extreme disturbances. Here, we analyse 45 years of the most comprehensive free-ranging non-human primate demographic dataset to determine the effects of major hurricanes on the variability and maintenance of long-term population fitness. For this, we use individual-level data to build matrix population models and perform perturbation analyses. Despite reductions in population growth rate mediated through reduced fertility, our study reveals a demographic buffering during hurricane years. As long as survival does not decrease, our study shows that hurricanes do not result in detrimental effects at the population level, demonstrating the unbalanced contribution of survival and fertility to population fitness in long-lived animal populations.

scholarly journals Effect of short-stay service use on stay-at-home duration for elderly with certified care needs: Analysis of long-term care insurance claims data in Japan

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0203112 ◽  
Author(s):  
Yoko Moriyama ◽  
Nanako Tamiya ◽  
Akira Kawamura ◽  
Thomas D. Mayers ◽  
Haruko Noguchi ◽  
...  
Keyword(s):  
Service Use ◽  
Long Term Care ◽  
Claims Data ◽  
Needs Analysis ◽  
Short Stay ◽  
Care Needs ◽  
Term Care ◽  
Insurance Claims Data ◽  
Long Term Care Insurance

scholarly journals A Case-Mix System for Adults with Developmental Disabilities

2019 ◽  
Vol 12 ◽  
pp. 117863291985601 ◽  
Author(s):  
Brant E Fries ◽  
Mary L James ◽  
Lynn Martin ◽  
Michael J Head ◽  
Shannon L Stewart ◽  
...  
Keyword(s):  
Social Services ◽  
Population Level ◽  
Assessment System ◽  
Case Mix ◽  
Care Needs ◽  
Payment Reform ◽  
Level Data ◽  
Adults With Intellectual Disabilities ◽  
Cost Efficient ◽  
The Cost

Effective management of publicly funded services matches the provision of needed services with cost-efficient payment methods. Payment systems that recognize differences in care needs (eg, case-mix systems) allow for greater proportions of available funds to be directed to providers supporting individuals with more needs. We describe a new way to allocate funds spent on adults with intellectual disabilities (ID) as part of a system-wide Medicaid payment reform initiative in Arkansas. Analyses were based on population-level data for persons living at home, collected using the interRAI ID assessment system, which were linked to paid service claims. We used automatic interactions detection to sort individuals into unique groups and provide a standardized relative measure of the cost of the services provided to each group. The final case-mix system has 33 distinct final groups and explains 26% of the variance in costs, which is similar to other systems in health and social services sectors. The results indicate that this system could be the foundation for a future case-mix approach to reimbursement and stand the test of “fairness” when examined by stakeholders, including parents, advocates, providers, and political entities.

Long-term retreatment rates of cerebral aneurysms in a population-level cohort

2018 ◽  
Vol 11 (4) ◽  
pp. 367-372
Author(s):  
Taylor Daileda ◽  
Farhaan S Vahidy ◽  
Peng Roc Chen ◽  
Hooman Kamel ◽  
Conrad W Liang ◽  
...  
Keyword(s):  
Cerebral Aneurysms ◽  
Population Level ◽  
Surgical Clipping ◽  
Treatment Practices ◽  
Level Data ◽  
Treatment Type ◽  
Retreatment Rate ◽  
Procedure Codes ◽  
Index Treatment

BackgroundThe likelihood of retreatment in patients undergoing procedures for cerebral aneurysms (CAs) has an important role in deciding the optimal treatment type. Existing determinations of retreatment rates, particularly for unruptured CAs, may not represent current clinical practice.ObjectiveTo use population-level data to examine a large cohort of patients with treated CAs over a 10-year period to estimate retreatment rates for both ruptured and unruptured CAs and explore the effect of changing treatment practices.MethodsWe used administrative data from all non-federal hospitalizations in California (2005–2011) and Florida (2005–2014) and identified patients with treated CAs. Surgical clipping (SC) and endovascular treatments (ETs) were defined by corresponding procedure codes and an accompanying code for ruptured or unruptured CA. Retreatment was defined as subsequent SC or ET.ResultsAmong 19 482 patients with treated CAs, ET was performed in 12 007 (62%) patients and SC in 7475 (38%). 9279 (48%) patients underwent treatment for unruptured CAs and 10203 (52%) for ruptured. Retreatment after 90 days occurred in 1624 (8.3%) patients (11.2% vs 3.7%, ET vs SC). Retreatment rates for SC were greater in unruptured than in ruptured aneurysms (4.6% vs 3.1%), but the opposite was true for ET (10.6% vs 11.8%). 85% of retreatments were within 2 years of the index treatment. Retreatment was associated with age (OR=0.99, 95% CI 0.98 to 0.99), female sex (OR=1.5, 95% CI 1.3 to 1.7), Hispanic versus white race (OR=0.86, 95% CI 0.75 to 0.98), and ET versus SC (OR=3.25, 95% CI 2.85 to 3.71). The adjusted 2-year retreatment rate decreased from 2005 to 2012 for patients with unruptured CAs treated with ET (11% to 8%).ConclusionsRetreatment rates for CAs treated with ET were greater than those for SC. However, for patients with unruptured CAs treated with ET, we identify a continuous decline in retreatment rate over the past decade.

The Proactive Patient: Long-Term Care Insurance Discrimination Risks of Alzheimer's Disease Biomarkers

2018 ◽  
Vol 46 (2) ◽  
pp. 485-498 ◽  
Author(s):  
Jalayne J. Arias ◽  
Ana M. Tyler ◽  
Benjamin J. Oster ◽  
Jason Karlawish
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Long Term Care ◽  
Term Care ◽  
State Laws ◽  
Disease Biomarkers ◽  
Care Services ◽  
Report Data ◽  
Services And Supports

Previously diagnosed by symptoms alone, Alzheimer's disease is now also defined by measures of amyloid and tau, referred to as “biomarkers.” Biomarkers are detectible up to twenty years before symptoms present and open the door to predicting the risk of Alzheimer's disease. While these biomarkers provide information that can help individuals and families plan for long-term care services and supports, insurers could also use this information to discriminate against those who are more likely to need such services. In this article, we evaluate whether state laws prohibit long-term care insurers from making discriminatory or unfair underwriting and coverage decisions based Alzheimer's disease biomarkers status. We report data demonstrating that current state laws do not provide meaningful protections from discrimination by long-term care insurers based on biomarker information.

scholarly journals Scoping Review: Home and Community-Based Service Waiver Programs and Person-Reported Outcomes

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 848-849
Author(s):  
Taylor Bucy ◽  
John Mulcahy ◽  
Eric Jutkowitz ◽  
Tetyana Shippee
Keyword(s):  
Scoping Review ◽  
Service Use ◽  
Long Term Care ◽  
Medication Management ◽  
International Studies ◽  
Care Needs ◽  
Community Based ◽  
Term Care ◽  
Use Patterns

Abstract State Medicaid programs are rebalancing their long-term care spending from nursing home to home and community-based services (HCBS). Emphasis on person-centered and person-directed care warrants investigation into models of HCBS delivery that promote quality of life. We performed a scoping review of the literature to catalogue the breadth of the studies describing HCBS waiver programs targeting adults (18+). We identified 757 articles, and after duplicate removal and reconciliation, we excluded articles on children or adolescents, non-peer reviewed reports, international studies, and articles that did not describe HCBS waiver programs. After abstract and title review, 292 articles met our inclusion criteria. Most included articles (22.3%) were single state descriptive evaluations or evaluations of service use patterns among participants. 17.8% of included articles examined multi-state or national variation in program trends, while 17.1% made national program conclusions without a major focus on interstate comparison. Less common were studies examining integrated care or dual-eligibles (7.5%), PACE (3.4%), medication management (3.1%), quality and satisfaction of both consumer and caretaker perspectives (3.8%) and consumer-only perspectives (5.1%). The remaining articles focused on HIV (4.1%), TBI (1.4%) or ID/DD (14.4%) waiver programs. The 8.9% of articles addressing quality and satisfaction consisted mostly of interviews, either with state Medicaid administrators or with care recipients and/or caregivers. Consumer reported satisfaction and unmet care needs were the primary outcomes examined. Given the heightened focus on long-term care as a result of the ongoing coronavirus pandemic, this review justifies further exploration into the delivery and outcomes of state-directed HCBS waiver programs.

Corporal Punishment and the Law in Global Perspective

2019 ◽  
pp. 292-320 ◽  
Author(s):  
Joan E. Durrant
Keyword(s):  
New Zealand ◽  
Public Education ◽  
Corporal Punishment ◽  
Large Scale ◽  
Population Level ◽  
Global Perspective ◽  
Violence Against Children ◽  
Level Data ◽  
Primary Focus

Debates over corporal punishment’s effectiveness have come to an end. No study has shown it to have long-term benefits, while many have demonstrated its substantial and wide-ranging risks. Today, the primary focus is on ending it. The increasing recognition of children as rights-bearers is leading an ever-growing number of countries to legally prohibit corporal punishment of children. These laws are intended to foster recognition of children’s rights to protection from all violence, reduce approval and use of corporal punishment, and lower the threshold for tolerance of violence against children. Population-level data from Sweden, Germany, and New Zealand indicate that these changes are taking place. Additional research suggests that a combination of prohibition and large-scale public education is the most effective route to ending the corporal punishment of children.

scholarly journals Hurricane-induced demographic changes in a nonhuman primate population

2020 ◽  
Author(s):  
Dana O. Morcillo ◽  
Ulrich K. Steiner ◽  
Kristine L. Grayson ◽  
Angelina V. Ruiz-Lambides ◽  
Raisa Hernández-Pacheco
Keyword(s):  
Nonhuman Primate ◽  
Population Level ◽  
Matrix Population Models ◽  
Individual Level ◽  
Animal Populations ◽  
Level Data ◽  
Climatic Event ◽  
Free Ranging ◽  
Population Fitness

AbstractMajor disturbance events can have large impacts on the demography and dynamics of animal populations. Hurricanes are one example of an extreme climatic event, predicted to increase in frequency due to climate change, and thus expected to be a considerable threat to population viability. However, little is understood about the underlying demographic mechanisms shaping population response following these extreme disturbances. Here, we analyze 45 years of the most comprehensive free-ranging nonhuman primate demographic dataset to determine the effects of major hurricanes on the variability and maintenance of long-term population fitness. For this, we use individual-level data to build matrix population models and perform perturbation analyses. Despite reductions in population growth rate mediated through reduced fertility, our study reveals a demographic buffering during hurricane years. As long as survival does not decrease, our study shows that hurricanes do not result in detrimental effects at the population level, demonstrating the unbalanced contribution of survival and fertility to population fitness in long-lived animal populations.

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