THE IMPACT OF SOCIAL DIVERSITY ON RESIDENT CARE: A COMPARISON OF FIVE TEAMS AT A CARE ORGANIZATION

Studies have long noted challenges of diversity in the workplace. Growing evidence suggests that both the aging population and the workforce needed for health and social care will be more diverse than in previous decades. The confluence of older person and care worker diversity can result in suboptimal care. Drawing on 44 interviews, observations of 62 meetings, and a five-year immersion, this organizational ethnography examines the impact of social diversity at a large, urban, multi-level, residential care organization for older persons. The impact of diversity is delineated on three levels such as among care workers, between care workers and residents, and in terms of personal and organizational responsibility for diversity work. Strengths of diversity are mainly with regard to connectivity between care workers and residents. Diversity challenges include implications for care processes, care workers’ identities, and organizational health.

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Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti

Global Mental Health ◽

10.1017/gmh.2021.17 ◽

2021 ◽

Vol 8 ◽

Author(s):

Alexandra L. Rose ◽

Ryan McBain ◽

Jesse Wilson ◽

Sarah F. Coleman ◽

Emmanuel Mathieu ◽

...

Keyword(s):

Mental Health ◽

Clinical Outcomes ◽

Positive Impact ◽

International Health ◽

Routine Care ◽

Care Organization ◽

Depression Care ◽

Resource Limited Settings ◽

Resource Limited ◽

The Impact

Abstract Background There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. Methods For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. Results 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. Conclusions Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.

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Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

Innovation in Aging ◽

10.1093/geroni/igaa057.2810 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 777-777

Author(s):

Qian-Li Xue ◽

Kristine Ensrud ◽

Shari Lin

Keyword(s):

Cohort Studies ◽

Healthcare Utilization ◽

Risk Adjustment ◽

Healthcare Services ◽

Self Report ◽

Added Value ◽

Care Organization ◽

Frailty Phenotype ◽

Frailty Assessment ◽

The Impact

Abstract As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

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Adjusting Client-Level Risks Impacts on Home Care Organization Ranking

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115502 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5502

Author(s):

Aylin Wagner ◽

René Schaffert ◽

Julia Dratva

Keyword(s):

Risk Factors ◽

Home Care ◽

Risk Adjustment ◽

Care Quality ◽

Assessment Instrument ◽

Care Organization ◽

Discrimination Power ◽

Adjustment Model ◽

Risk Adjustment Model ◽

The Impact

Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan

Family Medicine ◽

10.22454/fammed.2020.334308 ◽

2020 ◽

Vol 52 (6) ◽

pp. 417-421

Author(s):

Ian Nelligan ◽

Tamara Montacute ◽

Michael-Anne Browne ◽

Steven Lin

Keyword(s):

Family Medicine ◽

Health Plan ◽

Average Cost ◽

Primary Care Physicians ◽

Health Spending ◽

Cost Of Care ◽

Care Organization ◽

Data Set ◽

The Impact ◽

Minor Procedure

Background and Objectives: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians. Methods: We examined claims data for procedures performed on patients insured under our AMC’s home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI). Results: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33. Conclusion: A family medicine minor procedure service significantly lowered health spending at our AMC.

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The Impact of Allergy and Pulmonary Specialist Care on Emergency Asthma Utilization in a Large Managed Care Organization

Health Services Research ◽

10.1111/j.1475-6773.2005.00410.x ◽

2005 ◽

Vol 40 (5p1) ◽

pp. 1443-1465 ◽

Cited By ~ 27

Author(s):

Sara Erickson ◽

Irina Tolstykh ◽

Joe V. Selby ◽

Guillermo Mendoza ◽

Carlos Iribarren ◽

...

Keyword(s):

Managed Care ◽

Care Organization ◽

Specialist Care ◽

Managed Care Organization ◽

The Impact

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The stroke mothership model survived during COVID-19 era: an observational single-center study in Emilia-Romagna, Italy

Neurological Sciences ◽

10.1007/s10072-020-04754-2 ◽

2020 ◽

Vol 41 (12) ◽

pp. 3395-3399

Author(s):

Andrea Zini ◽

Michele Romoli ◽

Mauro Gentile ◽

Ludovica Migliaccio ◽

Cosimo Picoco ◽

...

Keyword(s):

Ischemic Stroke ◽

Treatment Time ◽

Combined Treatment ◽

Temporal Trends ◽

Stroke Care ◽

Minor Stroke ◽

Care Organization ◽

Stroke Patients ◽

Stroke Center ◽

The Impact

Abstract Introduction A reduction of the hospitalization and reperfusion treatments was reported during COVID-19 pandemic. However, high variability in results emerged, potentially due to logistic paradigms adopted. Here, we analyze stroke code admissions, hospitalizations, and stroke belt performance for ischemic stroke patients in the metropolitan Bologna region, comparing temporal trends between 2019 and 2020 to define the impact of COVID-19 on the stroke network. Methods This retrospective observational study included all people admitted at the Bologna Metropolitan Stroke Center in timeframes 1 March 2019–30 April 2019 (cohort-2019) and 1 March 2020–30 April 2020 (cohort-2020). Diagnosis, treatment strategy, and timing were compared between the two cohorts to define temporal trends. Results Overall, 283 patients were admitted to the Stroke Center, with no differences in demographic factors between cohort-2019 and cohort-2020. In cohort-2020, transient ischemic attack (TIA) was significantly less prevalent than 2019 (6.9% vs 14.4%, p = .04). Among 216 ischemic stroke patients, moderate-to-severe stroke was more represented in cohort-2020 (17.8% vs 6.2%, p = .027). Similar proportions of patients underwent reperfusion (45.9% in 2019 vs 53.4% in 2020), although a slight increase in combined treatment was detected (14.4% vs 25.4%, p = .05). Door-to-scan timing was significantly prolonged in 2020 compared with 2019 (28.4 ± 12.6 vs 36.7 ± 14.6, p = .03), although overall timing from stroke to treatment was preserved. Conclusion During COVID-19 pandemic, TIA and minor stroke consistently reduced compared to the same timeframe in 2019. Longer stroke-to-call and door-to-scan times, attributable to change in citizen behavior and screening at hospital arrival, did not impact on stroke-to-treatment time. Mothership model might have minimized the effects of the pandemic on the stroke care organization.

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Interpreting the Meaning of Pain Severity Scores

Pain Research and Management ◽

10.1155/2002/971935 ◽

2002 ◽

Vol 7 (4) ◽

pp. 192-198 ◽

Cited By ~ 29

Author(s):

Marilyn J Hodgins

Keyword(s):

Health Care ◽

Pain Management ◽

Health Care Professionals ◽

Pain Measurement ◽

Management Practices ◽

Care Organization ◽

Treatment Goals ◽

Severity Scores ◽

Measurement Tools ◽

The Impact

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients' pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.

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Automated telephone reminders: Potential to improve adherence to adjuvant hormonal therapy among patients with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.297 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 297-297 ◽

Cited By ~ 4

Author(s):

Virginia P. Quinn ◽

Joanne E. Schottinger ◽

Kelley R. Green ◽

Craig T. Cheetham

Keyword(s):

Breast Cancer ◽

Hormonal Therapy ◽

Health Care Organization ◽

Medication Possession Ratio ◽

Care Organization ◽

Adjuvant Hormonal Therapy ◽

Kaiser Permanente ◽

Telephone Reminder ◽

The Impact ◽

Recommended Therapy

297 Background: As the U.S. population ages and life expectancy lengthens, the number of new estrogen receptor positive (ER+) breast cancer (bca) cases is expected to grow substantially from the current 150,000/year. Numerous studies show that adjuvant hormonal therapy (AHT) dramatically reduces bca recurrence (by 50%) and mortality (by 30%) among ER+ women. Daily treatment for 5 years is the recommended therapy. Yet, reports of under-utilization are alarming, ranging from 30% to more than 50%. Methods: We examined utilization of AHT among members of Kaiser Permanente Southern California, a nonprofit prepaid health care organization serving 3.6 million socio-economically diverse members. We identified 10,827 women diagnosed with bca between 2000 and 2007 from the plan’s SEER-affiliated cancer registry who were eligible for AHT. We used automated pharmacy records to assess uptake and utilization of AHT (primarily tamoxifen (TAM) and aromatase inhibitors (AIs)). Results: In this insured population, we found 14% of eligible bca survivors did not begin AHT. Among women who started AHT, over 30% had sub-optimal adherence defined as a medication possession ratio <80%. Discontinuation of AHT, defined as >90 days without medication, began in year 1 (7%) and reached 25% by year 5. To address this threat to quality bca care, the health plan recently initiated an innovative automated telephone reminder (ATR) system among women who filled at least 1 prescription for TAM. Each month, ATR calls are made to about 125 women >18 years, who are overdue between 2 and 6 weeks for a refill, and who have not developed intolerance to TAM or switched to an AI. To date, ATR calls have generated no or few complaints. Next steps include evaluation of the impact of the system on adherence to TAM and, subsequently, AIs, and incorporation of electronic prompts to clinical staff for follow-up with non-responders. Conclusions: Monitoring and intervention for improving adherence to AHT needs to begin at initiation and continue across the 5 years of recommended therapy. AVR can reach large numbers of bca survivors and may have the potential to ensure they receive optimal benefit from these life-saving treatments.

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