scholarly journals Building Better Caregivers: A Pragmatic 12-Month Trial of a Community-Based Workshop for Caregivers of Cognitively Impaired Adults

2017 ◽  
Vol 38 (9) ◽  
pp. 1228-1252 ◽  
Author(s):  
Kate Lorig ◽  
Philip L. Ritter ◽  
Diana D. Laurent ◽  
Veronica Yank
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Linear Models ◽  
Self Report ◽  
Caregiver Strain ◽  
Care Utilization ◽  
Caregiver Health ◽  
Secondary Outcomes ◽  
Self Report Data

Building Better Caregivers (BBC), a community 6-week, peer-led intervention, targets family caregivers of those with cognitive impairments. BBC was implemented in four geographically scattered areas. Self-report data were collected at baseline, 6 months, and 1 year. Primary outcome were caregiver strain and depression. Secondary outcomes included caregiver burden, stress, fatigue, pain, sleep, self-rated health, exercise, self-efficacy, and caregiver and care partner health care utilization. Paired t tests examined 6 month and 1-year improvements. General linear models examined associations between baseline and 6-month changes in self-efficacy and 12-month primary outcomes. Eighty-three participants (75% of eligible) completed 12-month data. Caregiver strain and depression improved significantly (Effect Sizes = .30 and .41). All secondary outcomes except exercise and caregiver health care utilization improved significantly. Baseline and 6-month improvements in self-efficacy were associated with improvements in caregiver strain and depression. In this pilot pragmatic study, BBC appears to assist caregivers while reducing care partner health care utilization. Self-efficacy appears to moderate these outcomes.

scholarly journals PMC7 SELF-REPORT VERSUS CAREGIVER REPORT OF HEALTH CARE UTILIZATION: IMPACT ON COST AND COST-EFFECTIVENESS

2008 ◽  
Vol 11 (6) ◽  
pp. A561
Author(s):  
M Hoogendoorn ◽  
CR vanWetering ◽  
AM Schols ◽  
MP Rutten-van Mölken
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Utilization ◽  
Self Report ◽  
Care Utilization ◽  
Caregiver Report

Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 155-155
Author(s):  
Elizabeth Ann Kvale ◽  
Gabrielle Rocque ◽  
Kerri S. Bevis ◽  
Aras Acemgil ◽  
Richard A. Taylor ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Healthcare Utilization ◽  
Linear Models ◽  
Care Utilization ◽  
Deep South ◽  
Medicare Beneficiaries ◽  
Aggressive Care ◽  
The Impact

155 Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends.

T1165 Hearsay: Is Patient Self-Report of Health Care Utilization Accurate?

2008 ◽  
Vol 134 (4) ◽  
pp. A-498 ◽  
Author(s):  
Teresa Longobardi ◽  
Charles N. Bernstein
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Self Report ◽  
Care Utilization

scholarly journals Improving Self-Management Skills Among People With Spinal Cord Injury: Protocol for a Mixed-Methods Study (Preprint)

2018 ◽  
Author(s):  
W Ben Mortenson ◽  
Patricia Branco Mills ◽  
Jared Adams ◽  
Gurkaran Singh ◽  
Megan MacGillivray ◽  
...  
Keyword(s):  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Self Management ◽  
Care Utilization ◽  
Management Skills ◽  
Secondary Complications ◽  
Cord Injury

BACKGROUND Most people with spinal cord injury will develop secondary complications with potentially devastating consequences. Self-management is a key prevention strategy for averting the development of secondary complications and their recurrence. Several studies have shown that self-management programs improve self-management behaviors and health outcomes in individuals living with chronic conditions such as asthma, diabetes, hypertension, and arthritis. Given the burgeoning health care costs related to secondary complications, we developed an alternative electronic health–based implementation to facilitate the development of self-management skills among people with spinal cord injury. OBJECTIVE This study aims to evaluate the efficacy of a self-management app in spinal cord injury populations. The primary outcome is attainment of self-selected, self-management goals. Secondary outcomes include increases in general and self-management self-efficacy and reductions in self-reported health events, health care utilization, and secondary complications related to spinal cord injury. This study also aims to explore how the intervention was implemented and how the app was experienced by end users. METHODS This study will employ a mix of qualitative and quantitative methods. The quantitative portion of our study will involve a rater-blinded, randomized controlled trial with a stepped wedge design (ie, delayed intervention control group). The primary outcome is successful goal attainment, and secondary outcomes include increases in self-efficacy and reductions in self-reported health events, health care utilization, and secondary conditions related to spinal cord injury. The qualitative portion will consist of semistructured interviews with a subsample of the participants. RESULTS We expect that the mobile self-management app will help people with spinal cord injury to attain their self-management goals, improve their self-efficacy, reduce secondary complications, and decrease health care utilization. CONCLUSIONS If the results are positive, this study will produce credible new knowledge describing multiple outcomes that people with spinal cord injury realize from an app-based self-management intervention and support its implementation in clinical practice. CLINICALTRIAL ClinicalTrials.gov NCT03140501; http://clinicaltrials.gov/ct2/show/NCT03140501 (Archived by WebCite at http://www.webcitation.org/73Gw0ZlWZ) INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11069

Self-Regulation Strategies as Predictors: Managing Multimorbidities Among Community-Dwelling People Aging with Arthritis

2020 ◽  
Vol 42 (9) ◽  
pp. 698-707 ◽  
Author(s):  
Wenhui Zhang ◽  
Kavita Radhakrishnan ◽  
Heather Becker ◽  
Gayle J. Acton ◽  
Carole K. Holahan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Self Regulation ◽  
Health Resources ◽  
Physical Symptoms ◽  
Community Dwelling ◽  
Care Utilization ◽  
Multiple Chronic Conditions ◽  
Regulation Strategies

Self-regulation (SR) has been defined as consisting of three basic strategies: selection, optimization, and compensation. This study investigates these three SR strategies as predictors of arthritis self-efficacy, quality of life (QOL), and health-care utilization in community-dwelling people aging with arthritis and comorbidities. One hundred forty individuals over age 50 years provided demographic characteristics and completed surveys on comorbidities, health resources, use of SR strategies, symptoms, arthritis self-efficacy, QOL, and health-care utilization. Multivariate hierarchical stepwise regressions were used to examine SR strategies as predictors for arthritis self-efficacy, and together with arthritis self-efficacy as predictors for health-care utilization, and QOL. Physical symptoms; SR strategies, especially optimization; and income adequacy significantly predicted arthritis self-efficacy. Arthritis self-efficacy and mental and physical symptoms significantly predicted QOL. This study adds evidence to support the role of SR strategies, especially optimization, in building arthritis self-efficacy for better self-management and QOL in persons with arthritis and multiple chronic conditions.

USING TELEHEALTH INTERVENTIONS TO PREVENT PRESSURE ULCERS IN NEWLY INJURED SPINAL CORD INJURY PATIENTS POST-DISCHARGE

1999 ◽  
Vol 15 (4) ◽  
pp. 749-766 ◽  
Author(s):  
V. L. Phillips ◽  
Ann Temkin ◽  
Susan Vesmarovich ◽  
Richard Burns ◽  
Lynda Idleman
Keyword(s):  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health Care Utilization ◽  
Pressure Ulcers ◽  
Injury Rate ◽  
Self Report ◽  
Care Utilization ◽  
Cord Injury ◽  
Employment Rates

Objective: To determine which of three approaches to care produces the lowest incidence of pressure ulcers, promotes the most effective care of sores that develop, and leads to the fewest hospitalizations in newly injured patients with spinal cord injury after discharge.Methods: Spinal cord injury patients (n = 12) were recruited for a telehealth intervention after initial injury, and matched cases were recruited for telephone counseling and standard care groups. Patients were monitored for 6–8 months after discharge.Results: The video group had the greatest number of reported and identified pressure ulcers. Differences in health care utilization between the video and telephone telehealth groups were small. The standard care group reported the lowest number of pressure ulcers and lowest frequency of health care utilization. Substantial differences existed in employment rates before and after injury. The video group had the lowest pre-injury rate of employment and the highest post-injury rate of employment.Conclusions: Tracking pressure ulcer incidence, particularly stage I sores, is difficult. Self-report is likely to lead to substantial underreporting. Similarly, self-report on health care utilization over extended periods may lead to undercounting of encounters. Telehealth interventions appear to improve ulcer tracking and management of all ulcer occurrences. Video interventions may affect outcomes, such as employment rates, which are not conventionally measured.

scholarly journals A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial

10.2196/14408 ◽  
2019 ◽  
Vol 7 (10) ◽  
pp. e14408 ◽  
Author(s):  
Lonneke Boer ◽  
Erik Bischoff ◽  
Maarten van der Heijden ◽  
Peter Lucas ◽  
Reinier Akkermans ◽  
...  
Keyword(s):  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Self Efficacy ◽  
Respiratory Symptoms ◽  
Action Plan ◽  
Intervention Group ◽  
Self Management ◽  
Care Utilization ◽  
Management Behavior

Background Many patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs. Objective This study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals. Methods In a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models. Results Of the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good. Conclusions This study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan. Trial Registration ClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096.

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