scholarly journals Comprehensive home-based care coordination for vulnerable elders with dementia: Maximizing Independence at Home-Plus—Study protocol

2017 ◽  
Vol 20 (4) ◽  
pp. 123-134 ◽  
Author(s):  
Quincy M Samus ◽  
Karen Davis ◽  
Amber Willink ◽  
Betty S Black ◽  
Melissa Reuland ◽  
...  
Keyword(s):  
Health Care ◽  
Care Coordination ◽  
Life Quality ◽  
Health Care Expenditures ◽  
Dementia Care ◽  
Term Care ◽  
Health Care Innovation ◽  
The Impact ◽  
Care Innovation ◽  
At Home

Introduction Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs. This report provides an overview of the Health Care Innovation Award aims, study design, and methodology. Methods This is a prospective, quasi-experimental intervention study of 342 community-living Medicare–Medicaid dual eligibles and Medicare-only beneficiaries with dementia in Maryland. Primary analyses will assess the impact of Maximizing Independence at Home-Plus on risk of nursing home long-term care placement, hospitalization, and health care expenditures (Medicare, Medicaid) at 12, 18 (primary end point), and 24 months, compared to a propensity-matched comparison group. Discussion The goals of the Maximizing Independence at Home-Plus model are to improve care coordination, ability to remain at home, and life quality for participants and caregivers, while reducing total costs of care for this vulnerable population. This Health Care Innovation Award project will provide timely information on the impact of Maximizing Independence at Home-Plus care coordination model on a variety of outcomes including effects on Medicaid and Medicare expenditures and service utilization. Participant characteristic data, cost savings, and program delivery costs will be analyzed to develop a risk-adjusted payment model to encourage sustainability and facilitate spread.

scholarly journals Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program

2016 ◽  
Vol 52 (1) ◽  
pp. 291-312 ◽  
Author(s):  
Megan Skillman ◽  
Caitlin Cross-Barnet ◽  
Rachel Friedman Singer ◽  
Sarah Ruiz ◽  
Christina Rotondo ◽  
...  
Keyword(s):  
Health Care ◽  
Care Coordination ◽  
Engagement Strategies ◽  
Physician Engagement ◽  
Health Care Innovation ◽  
Care Innovation

scholarly journals Impact of Informal Care on Health Care Utilization Among Older People in China

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 334-334
Author(s):  
Yixiao Wang
Keyword(s):  
Health Care ◽  
Older People ◽  
Informal Care ◽  
Outpatient Care ◽  
Inpatient Care ◽  
Health Care Expenditures ◽  
Chinese Government ◽  
Term Care ◽  
Variable Approach ◽  
The Impact

Abstract Population aging has become a challenge to long-term care and health care for the society. Using China as a case study, this paper assesses allocative efficiency of resources in informal care and health care, to explore the effectiveness of the policy, i.e., encouraging informal care as a more cost-effective way to reduce public health care spending. Drawing data from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the impact of informal care on utilization of health care as well as amount of health care expenditures among older people with functional limitations in China. Using random effects model with instrumental variable approach, our findings suggest that informal care significantly reduces the utilization of health care, primarily by reducing the utilization of outpatient care. However, informal care significantly increases the amount of inpatient care expenditures for inpatient care users. We do not observe significant association between informal care and amount of outpatient care expenditures for outpatient care users. This study highlights a pressing need for the Chinese government to support informal caregivers by taking economic values of informal caregiving into consideration, and to improve efficiency in inpatient care by a more integrated resource allocation mechanism

scholarly journals Ageing, limb-loss and military veterans: a systematic review of the literature

2018 ◽  
Vol 39 (8) ◽  
pp. 1582-1610 ◽  
Author(s):  
NICK CADDICK ◽  
HELEN CULLEN ◽  
AMANDA CLARKE ◽  
MATT FOSSEY ◽  
MICHAEL HILL ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Military Service ◽  
Military Veterans ◽  
Limb Loss ◽  
Cochrane Library ◽  
Term Care ◽  
Long Term Impact ◽  
The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

scholarly journals The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

2020 ◽  
Author(s):  
Jochen René Thyrian ◽  
Friederike Kracht ◽  
Angela Nikelski ◽  
Melanie Boekholt ◽  
Fanny Schumacher-Schönert ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Provision ◽  
Social Activities ◽  
Care Provision ◽  
Convenience Sample ◽  
Personal Impact ◽  
The Impact ◽  
At Home

Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods: This analysis is based on data of a telephone-based assessment in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results: The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions: The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

Randomized Trial of a Health Promotion Program For Frail Elders

1992 ◽  
Vol 11 (1) ◽  
pp. 72-91 ◽  
Author(s):  
Nancy Hall ◽  
Paula De Beck ◽  
Debra Johnson ◽  
Kelly Mackinnon ◽  
Gloria Gutman ◽  
...  
Keyword(s):  
Health Care ◽  
Health Promotion ◽  
Treatment Group ◽  
Community Services ◽  
Personal Health ◽  
Control Group ◽  
Elderly Persons ◽  
Term Care ◽  
Care At Home ◽  
At Home

AbstractThis study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls (n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group (n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients (n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant (p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

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